Perforator veins are so called because they perforate the

deep fascia Deep fascia (or investing fascia) is a fascia, a layer of dense connective tissue that can surround individual muscles and groups of muscles to separate into fascial compartments. This fibrous connective tissue interpenetrates and surrounds the ...

muscle Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of mus ...

s, to connect the

superficial vein Superficial veins are veins that are close to the surface of the body, as opposed to deep veins, which are far from the surface. Superficial veins are not paired with an artery, unlike the deep veins, which are typically associated with an art ...

s to the

deep vein A deep vein is a vein that is deep in the body. This contrasts with superficial veins that are close to the body's surface. Deep veins are almost always beside an artery with the same name (e.g. the femoral vein is beside the femoral artery). ...

s where they drain. Perforator veins play an essential role in maintaining normal blood draining. They have valves which prevent blood flowing back ( regurgitation) from deep to superficial veins in muscular

systole Systole ( ) is the part of the cardiac cycle during which some chambers of the heart contract after refilling with blood. The term originates, via New Latin, from Ancient Greek (''sustolē''), from (''sustéllein'' 'to contract'; from ...

or contraction. They exist along the length of the lower limb, in greater number in the leg (anatomical ref to below knee) than in the thigh. Some veins are named after the physician who first described them: *Dodd's perforator at the inferior 1/3 of the thigh *Boyd's perforator at the knee level *Cockett's perforators at the inferior 2/3 of the leg (usually there are three: superior medium and inferior Cockett perforators) Others have the name of the deep vein where they drain: *Medial gastrocnemius perforator, draining into the gastrocnemius vein *Fibular perforators, usually two, one superior near the lateral aspect of the knee and one inferior at the lateral aspect of the ankle When the valves of perforator veins become incompetent they can cause venous reflux when the muscles contract. This has been explained by Mark Whiteley as "active venous reflux". The resulting reflux can cause a rapid deterioration in an existing varicose disease and be responsible for the development of

venous ulcer Venous ulcer is defined by the American Venous Forum as "a full-thickness defect of skin, most frequently in the ankle region, that fails to heal spontaneously and is sustained by chronic venous disease, based on venous duplex ultrasound testing." ...

s. In the past, when varicose vein surgery is undertaken, the surgeon carefully ligated all perforators, but some believe that you can use conservative techniques to treat varicose disease use perforators to drain the superficial venous system. In this case, lower limbs venous ultrasonography plays an important role in evaluating which continent perforators can be used. However, increasing evidence (see below) is starting to favor the treatment of incompetent perforator veins by minimally invasive techniques such as TRansLuminal Occlusion of Perforators (TRLOP).

Clinical significance

Whether incompetent perforator veins (IPVs) require treatment or not is controversial, particularly when associated with the treatment of varicose veins. However research has shown that there is a clear association between the presence of IPVs and recurrent varicose veins. Before 1985, the ligation of IPVs needed open surgery. In 1985, G. Hauer described the Sub-fascial endoscopic perforator vein surgery (SEPS) technique allowing IPVs to be clipped through a small

incision Incision may refer to: * Cutting, the separation of an object, into two or more portions, through the application of an acutely directed force * A type of open wound caused by a clean, sharp-edged object such as a knife, razor, or glass splinter * ...

. SEPS was superseded in 2001 by a minimally invasive technique using pin hole surgery, called TRansLuminal Occlusion of Perforators (TRLOP) which by 2009 had shown to be as effective as SEPS in a 5-year study. As TRLOP can be performed under local anaesthetic and under ultrasound guidance, the advantages over the more invasive and painful SEPS were clear. In 2007 there was an attempt to rename TRLOP as PAPs (percutaneous ablation of perforators) but PAPs was seen to be merely a copy of the already described TRLOP procedure.

References

{{reflist Veins