ORIGINAL ARTICLE   

Acta Phlebologica 2019 August;20(2):48-56

DOI: 10.23736/S1593-232X.19.00441-7

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Clinical anatomy of the key perforating veins of the lower extremities

Roman E. KALININ, Igor A. SUCHKOV, Nina D. MZHAVANADZE, Ivan N. SHANAEV ✉

Department of Cardiovascular, Endovascular, Operative Surgery, and Topographic Anatomy, Ryazan State Medical University, Ryazan, Russia

BACKGROUND: Precise knowledge of venous anatomy is essential in phlebology. A solid understanding of clinical anatomy of the perforator veins (PVs) of the lower extremities is important for medical specialists involved in treating subjects with venous disorders.
METHODS: Venous anatomy was studied in 70 amputated lower extremities by anatomical dissection and 2800 patients by duplex ultrasonography.
RESULTS: There were four to six PVs located at the medial border of the foot; at the lateral border of the foot there were two to three PVs. These PVs had tributaries, which drained subcutaneous tissues of the lateral and medial surfaces of the foot, accordingly. Three to eight PVs were located at the medial surface of the calf. Relationship between the PVs and muscles, lamina profunda of fascia cruris, and sural veins characterized distal part of the medial surface of the calf as an area with increased hemodynamic load and rather weak muscular fascia. PVs in the popliteal fossa were rare, while a typical sapheno-popliteal junction was often absent. Among all PVs in the femoral region, key perforators were located in the middle and lower thirds of the medial thigh. These PVs were located along the medial intermuscular septum and connected deep veins with the great saphenous vein. Presence of an accompanying artery was confirmed in all perforator bundles, which suggested an additional mechanism of venous outflow.
CONCLUSIONS: Understanding of the clinical anatomy of PVs is necessary when treating patients with venous disorders. Additional mechanism of venous outflow was suggested.

KEY WORDS: Veins; Anatomy; Lower extremity