Journal of vascular surgery. Venous and lymphatic disorders · 2026
The anatomical conditions of the venous perforators of the medial side of the thigh in progressive chronic venous disease.
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Hnátková Gabriela, Hnátek Lukas, Kachlík David
Аннотация
OBJECTIVE: The aim of the study is to map the anatomical conditions of the venous perforators of the medial thigh to determine their functional relationship to the development of chronic venous disorder and the position of perforators based on their relationship to fixed structures of the lower limb, to map their branching in terms of communication with superficial veins, to evaluate their functional status, and to determine the indication for interventional surgery by ultrasound.
METHODS: A total of 371 venous perforators of the medial aspect of the thigh in 306 limbs were mapped. The examination was performed in a defined anatomical area of the ventromedial thigh, and the following boundaries were established: proximally, the saphenofemoral junction level; distally, the distal margin of the adductor canal; ventrally, a line running perpendicular to the anterior superior iliac spine; and dorsally, a line running perpendicular to the ischial tuberosity. To determine the location, the area under observation was divided into four equal zones in ascending order.
RESULTS: The highest number (274/73.9%) was observed in the second zone, whereas the lowest number (5/1.3%) was observed in the first zone; 47% of perforators branched from the great saphenous vein (GSV), 2% from the anterior accessory GSV, 1% from the posterior accessory GSV, 9% from the superficial accessory GSV, and 41% from a separate suprafascial vein. In 28%, the caliber was ≥3.5 mm with reflux >0.5 seconds; in 17%, the caliber was <3.5 mm with reflux >0.5 seconds; in 7%, the caliber was ≥3.5 mm with retrograde flow <0.5 seconds; and in 48%, the caliber was <3.5 mm with retrograde flow <0.5 seconds. During the application of foam sclerotherapy for the treatment, the echocontrast of the foam made the previously invisible subfascial branching of perforators visible.
CONCLUSIONS: The venous perforators of the medial aspect of the thigh can become a separate source of reflux into the superficial venous system, either as a primary source or as a secondary source of reflux in addition to the primary reflux in the superficial stem vein. An insufficient perforator may also prolong the duration of reflux in the stem vein. The caliber of the perforator does not affect the duration of reflux in itself.
METHODS: A total of 371 venous perforators of the medial aspect of the thigh in 306 limbs were mapped. The examination was performed in a defined anatomical area of the ventromedial thigh, and the following boundaries were established: proximally, the saphenofemoral junction level; distally, the distal margin of the adductor canal; ventrally, a line running perpendicular to the anterior superior iliac spine; and dorsally, a line running perpendicular to the ischial tuberosity. To determine the location, the area under observation was divided into four equal zones in ascending order.
RESULTS: The highest number (274/73.9%) was observed in the second zone, whereas the lowest number (5/1.3%) was observed in the first zone; 47% of perforators branched from the great saphenous vein (GSV), 2% from the anterior accessory GSV, 1% from the posterior accessory GSV, 9% from the superficial accessory GSV, and 41% from a separate suprafascial vein. In 28%, the caliber was ≥3.5 mm with reflux >0.5 seconds; in 17%, the caliber was <3.5 mm with reflux >0.5 seconds; in 7%, the caliber was ≥3.5 mm with retrograde flow <0.5 seconds; and in 48%, the caliber was <3.5 mm with retrograde flow <0.5 seconds. During the application of foam sclerotherapy for the treatment, the echocontrast of the foam made the previously invisible subfascial branching of perforators visible.
CONCLUSIONS: The venous perforators of the medial aspect of the thigh can become a separate source of reflux into the superficial venous system, either as a primary source or as a secondary source of reflux in addition to the primary reflux in the superficial stem vein. An insufficient perforator may also prolong the duration of reflux in the stem vein. The caliber of the perforator does not affect the duration of reflux in itself.