PERFORATING VEIN INSUFFICIENCY (INCOMPETENCE)

 

Perforating veins are vessels that connect superficial veins to deep veins. While the other veins in our legs are parallel to the leg, the perforating veins are perpendicular to the surface. They penetrate deep into the muscular layers and for this reason they are called perforating veins. The function of perforating veins is to transport deoxygenated blood from the superficial veins to the deep veins. The flow in the perforating veins is normally unidirectional from the surface to the deep, and each perforating vein has several valves that ensure this unidirectional flow. If these valves fail due to various reasons, the flow is reversed, from the deep to the surface resulting in perforating vein insufficiency. This insufficiency expands the superficial veins in that area after a certain period of time and varicose veins occur.

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Although there are approximately 150 perforating veins in our legs, the number of those who cause insufficiency does not exceed 30. A few of these are clinically important. Perforating insufficiency is most commonly seen in the outer and inner parts of the thigh above the knee, in the perforators below the knee and inside the calf.

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Sometimes, perforating vein insufficiency can expand the saphenous veins, causing "secondary" saphenous vein insufficiency. This is most commonly seen in the large saphenous vein inside the thigh and the small saphenous vein on the back of the knee. Insufficiency in perforating veins in these regions leads to pressure increase, dilation and valve failure in saphenous veins and classical saphenous vein insufficiency occurs in time. Such "secondary" saphenous vein insufficiency can be distinguished from classical saphenous vein insufficiency by a good color Doppler examination, which is important for treatment.

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The treatment of perforating vein insufficiency, like saphenous vein insufficiency, is based on the elimination of the incompetent perforating vein by means of laser or radiofrequency. Since perforating veins are curved and perpendicular to the skin, methods such as laser and radiofrequency are technically more challenging and should be performed by experienced physicians. Foam sclerotherapy alone is often not successful enough in large incompetent perforating veins. However, it is widely used in the treatment of varices due to perforating vein insufficiency.