Saphenous Vein-Sparing Strategies in Chronic Venous Disease by Paolo Zamboni Erika Mendoza & Sergio Gianesini

Author:Paolo Zamboni, Erika Mendoza & Sergio Gianesini
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

It has a flow towards the superficial vein in systole: it is the beginning of an open bypassing shunt and is part of the drainage of the leg.

6.9.1 Perforating Veins as a Reflux Source

A perforating vein can be considered a reflux source, if it has a flow towards the superficial vein in diastole. Only these will be interrupted in CHIVA. The flow can be:N1 → N2 from the deep vein into a saphenous vein

N1 → N3 from the deep vein into a tributary

The classical case of a refluxing perforating vein as reflux source for the saphenous vein (N1 → N2) is an incompetent perforating vein at the medial thigh feeding the GSV with refluxing (see Fig. 6.28c as an example). As a treatment, the interruption of the perforating vein is mostly recommended, though sometimes it is not necessary, if the diameter is not too large.

Another more frequent situation is an incompetent perforating vein at the back or lateral aspect of the thigh filling a tributary (N1 → N3). In this case, the treatment of the perforating vein can be surgical with phlebectomy of the tributary or both could be treated with sclerotherapy, depending on the diameter.

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