PREVALENCE AND DISTRIBUTION OF INCOMPETENT PERFORATING VEINS IN CHRONIC VENOUS INSUFFICIENCY

Purpose: The purpose of this study was the investigation of the preval ence and distribution of incompetent perforating veins (IPVs) in patie nts with different classes of chronic venous insufficiency (CVI) as de fined by the updated clinical, etiologic, anatomic, and pathologic cla ssification (CEAP) in relation to the pattern and the extent of venous reflux. Material and methods: The study included 468 limbs of 330 sub jects who ranged in age from 18 to 101 years (median, 49 years). The i nvestigation entailed a medical history, a clinical examination, and c olor now duplex imaging of the lower limb veins, which were performed by the same vascular surgeon operator. The patients were classified in to 7 clinical classes according to CEAP. The superficial and deep veno us systems were scanned, with an emphasis on the detection of IPVs. Ve nous reflux was considered abnormal when its duration exceeded 0.5 sec onds. IPVs were classified as medial, posterior, and anterolateral in the upper, middle, or lower third of the thigh or calf (9 thigh and 9 calf fields). Results: The IPVs were found mainly in the medial aspect , more frequently in the middle third of calf, followed by the lower c alf and the middle thigh. IPVs were rare in the lateral aspect of the thigh, the medial upper and posterior lower thigh and the posterior up per and lower calf. The prevalence of the IPVs and of deep Vein incomp etence increased significantly with the clinical severity of CVI (r = .95, P < .01, and r = .9, P < .01, respectively). In the limbs with a documented perforating vein (PV) incompetence, the ratios of calf-to-t high IPVs and of superfrcial-and-deep (S + D) over superficial-alone ( S; [S + D]/S) venous incompetence increase significantly (r = .87, P < .01 and r = .9, P < .01, respectively) with CEAP grade. The prevalenc e of reflux involving all systems (S + D + PV) increases significantly (r =.9, P < .01) with clinical severity In legs with CVI of CEAP 2 to 6, reflux was invariably proximal (thigh) and distal (below knee). Co nclusion: In CVI, IPVs are located predominately in the medial aspect of the lower extremity, more often in the middle third of the calf, fo llowed by the lower calf and middle thigh. The prevalence of IPVs and their calf-to-thigh ratio increase linearly with the clinical severity of CVI. Both the prevalence of deep Vein incompetence and the ratio o f superficial and deep to superficial ([S + D]/S) increase linearly wi th CEAP classification. These findings support the significant relatio nship between deep venous reflux and PV incompetence, although the lat ter may exist in the absence of the former. In CEAP classes 2 to 6, re flux is invariably proximal and distal. Incompetence involving all sys tems (S + D + PV) increases in prevalence with the severity of CVI.