Endoscopic anatomy of perforating veins in chronic venous insufficiency of the legs: “Solitary” incompetent perforating veins are often actually multiple vessels

Naoki Haruta; Ryo Shinhara; Keizo Sugino; Yasutomo Ojima; Masatugu Yano; Hiroshi Watanabe; Hideki Kawanishi; Takaaki Mochiduki; Toshimasa Asahara

doi:10.1007/s00547-004-1045-3

International Journal of Angiology, Table of Contents

Int J Angiol 2004; 13(1): 31-36
DOI: 10.1007/s00547-004-1045-3

Original Articles

Endoscopic anatomy of perforating veins in chronic venous insufficiency of the legs: “Solitary” incompetent perforating veins are often actually multiple vessels

Naoki Haruta¹ , Ryo Shinhara¹ , Keizo Sugino¹ , Yasutomo Ojima¹ , Masatugu Yano¹ , Hiroshi Watanabe¹ , Hideki Kawanishi¹ , Takaaki Mochiduki¹ , Toshimasa Asahara²

¹Medial Corporation Akane, Tsuchiya General Hospital, Hiroshima, Japan
²Second Department of Surgery, Faculty of Medicine, Hiroshima University, Hiroshima, Japan

Abstract

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Abstract

We have already reported on the effectiveness of subfascial, endoscopic, perforating-veins surgery for chronic venous insufficiency of the legs. The incompetent perforating vein (IPV) often appears to be a single vessel, when it is actually two or more vessels. Accordingly we examined the anatomy and features of IPVS. The features of perforating veins were assessed in 173 limbs of 152 patients. In the recent 50 limbs, 128 IPVs were subjected to complete dissection of the adventitia to confirm the number of vessels. Ninety-seven out of 110 IPVs (88.2%) had a concomitant artery. On endoscopy 128 IPVs could be classified into seven types (type N, type O, type I, type II, type III, type IV, and type V) according to the combination of arteries and veins which were presented. Type N means a normal perforator consisting of a single artery with a pair of normal veins running alongside it. Type O has the same anatomy as type N but shows reverse flow. Type I has an incompetent vein with thick walls and reverse flow, which is not accompanied by an artery. Type II is an artery associated with an incompetent vein. Type III is composed of an artery, a normal vein, and an incompetent vein. Type IV is an artery with two incompetent veins and type V contains multiple incompetent veins. When the anatomy of 128 IPVs was confirmed, the number of each type was as follows: 7 type O (5%), 32 type I (25%), 1 type II (1%), 48 type III (38%), 39 type IV (30%), and 1 type V (1%). This is the first report on all the components of IPVs directly visualized in vivo. It has been almost impossible to predict the postoperative reversibility of IPVs after surgical ablation of superficial veins. By using our classification of IPVs, it will be possible to treat only the irreversible (true) incompetent veins and to avoid operating on arteries, normal veins, and reversibly incompetent veins. In the future, it will be necessary to devise the operative strategy according to the type of IPVs as assessed by endoscopic examination.

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