Anatomy of Perforating veins of the lower limb

Zusammenfassung

Die Perforansvenen (PV) der unteren Extremitäten sind nicht nur gerade und direkte Verbindungen zwischen den tiefen und oberflächlichen Venennetzen, sondern bilden gemeinsam ein weit verzweigtes Netz. Trotz ihrer starken anatomischen Variabilität ist ihre Position bemerkenswert konstant und prognostizierbar. Dies ist durch ihre enge Beziehung zu den Muskelvenen bedingt und durch die hämodynamischen Ebenen entlang der Extremität zu erklären. Sie sind bei der Beurteilung durch Ultraschalluntersucher in der täglichen Praxis eine Hilfe.

Der anatomische Inhalt dieses Artikels stammt aus folgenden Quellen: Anatomische Präparationen von C. Gillot nach Latex-Injektion und anschließender farblicher Unterteilung von über 400 Extremitäten. Dreidimensionale Rekonstruktionen von CT-Venografien von 1200 Extremitäten und präoperativen Hautvenenvermessungen von 25 000 Extremitäten.

Es wird Folgendes beschrieben: Referenzpunkte der Extremität, Perforansvenen des Fußes, Beins und Sprunggelenks, der Wade, Anastomosen zwischen den Perforansvenen, Begleitarterien der Bein-PVs und Oberschenkel-PVs.

Abstract

The perforating veins (PVs) of the lower limbs are not just straight and direct communications between the deep and the superficial venous networks, they are commonly making a complex multi-branched network. Despite their great anatomical variability, their location is remarkably constant and predictable. This is due to their close relationship with the muscular veins, explained by the hemodynamical levels along the limb. This constitutes a help for their assessment by sonographers in daily practice.

The anatomical contents of this paper came from the following sources: Anatomical dissections by C. Gillot, after latex injection, then colored segmentation of more than 400 limbs. 3D reconstructions from CT venography of 1200 limbs and pre-surgical skin venous mapping of 25 000 limbs.

We successively describe: Landmarks of the limb, perforating veins of foot, leg and ankle, calf, interperforator anastomosis, accompanying arteries of leg PVs, popliteal fossa PVs, thigh PVs.

Key words

anatomy - perforating veins - 3D modeling - duplex US

Schlüsselwörter

Anatomie - Perforansvenen - 3-dimensionale Modellierung - Duplex-Sonografie

Publication History

Article published online:
17 February 2021

• References

• 1 Gillot C. Atlas of the superficial venous network of the lower limbs. Editions Phlébologiques Françaises. CD-Rom version (Uhl F.J) available in French, English and Spanish 1980.
• 2 Uhl JF, Gillot C. Embryology and 3D anatomy of the superficial venous system of the lower limbs. Phlebology 2007; 22 (05) 194-206
• 3 Uhl JF, Lo Vuolo M, Labropoulos N. Anatomy of the lymph node venous networks of the groin and their investigation by ultrasonography. Phlebology 2016; 31 (05) 334-343
• 4 Caggiati A, Bergan JJ, Gloviczki P. et al. Nomenclature of the veins of the lower limbs. J Vasc Surg 2002; 36: 416-422
• 5 Cavezzi A, Labropoulos N, Partsch H. et al. Duplex Ultrasound Investigation of the Veins in ChronicVenous Disease of the Lower Limbs-UIP Consensus Document. Part II. Anatomy. EJVES 2006; 31: 288-299
• 6 Uhl JF, Gillot C. The foot venous pump. Anatomy and physiology. Phlebolymphology 2010; 17: 151-158
• 7 Uhl JF, Gillot C. Anatomy of the foot venous pump: Physiology and influence on chronic venous disease. Phlebology 2012; 27: 219-230
• 8 Uhl JF, Gillot C, Chahim M. Foot static disorders: a major risk factor of CVD?. Phlebology 2012; 27: 13-18
• 9 Uhl JF, Lo Vuolo M, Gillot C. Anatomy of the perforator veins of the foot and ankle. Phlebolymphology 2017; 24 (02) 105-112
• 10 Lo Vuolo M. Venous Ultrasound. A comprehensive approach. Lower extremities and pelvis. Atlas and Texts. Info & sales: [e-mail]
• 11 Gillot C. Superficial veins of the leg. Morphologie (French) 1999; 83 (260) 19-28 . PMID: 10417989
• 12 Uhl JF, Gillot C. Anatomy of the veno-muscular pumps of the lower limb. Phlebology 2015; 30 (03) 180-193
• 13 Uhl JF, Verdeille S, Martin-Bouyer Y. Three-dimensional spiral CT venography for the pre-operative assessment of varicose patients. VASA 2003; 32 (02) 91-94
• 14 Uhl JF, Verdeille S, Martin-Bouyer Y. Pre-operative assessment of varicose patients by veno-CT with 3D reconstruction 3^rd International workshop on multislice CT 3D imaging Springer Verlag Ed pavone. Debatin; 2003: 51-53
• 15 Uhl JF, Caggiati A. (2005) Three-Dimensional Evaluation of the Venous System in Varicose Limbs by Multidetector Spiral CT. In: Catalano C, Passariello R. (eds) Multidetector-Row CT Angiography. Medical Radiology (Diagnostic Imaging). Springer; Berlin, Heidelberg: DOI: https://doi.org/10.1007/3-540-26984-3_15
• 16 Uhl JF, Chahim M, Verdeille S. et al. The 3D modeling of the venous system by MSCT venography (CTV): technique, indications and results. Phlebology 2012; 27: 270-288
• 17 Van Rij A, Hill G, Gray C. et al. A prospective study of the fate of venous leg perforators after varicose vein surgery. J Vasc Surg 2005; 42: 1156-1162
• 18 Thiery L. Surgical anatomy of the popliteal fossa. Phlébologie 1986; 39: 30-36
• 19 Delis KT, Knaggs AL, Hobbs JT. et al. The nonsaphenous vein of the popliteal fossa: prevalence, patterns of reflux, hemodynamic quantification, and clinical significance. J Vasc Surg 2006; 44 (03) 611-619
• 20 Ricci S, Georgiev M, Jawien A. et al. Sciatic nerve varices. Eur J Vasc Endovasc Surg 2005; 29 (01) 83-87
• 21 Mendoza E. Duplex-Untersuchung von Perforansvenen. Phlebologie 2014; 43: 206-209 . doi:http://dx.doi.org/10.12687/phleb2211-4-2014
• 22 Mendoza E, Lattimer CR, Morrison N. (eds.) Duplex Ultrasound of Superficial Leg Veins. 187. 2014. DOI: 10.1007/978-3-642-40731-4_9 , © Springer-Verlag