Perforating vein

Term used in phlebology to describe a vein perforating the muscle fascia and connecting the deep venous system with the superficial venous system. Perforating veins (PV) are physiologically 0.1 to 0.2 cm thick. They are equipped with venous valves and regulate the blood flow between the two venous systems. The blood flow in the perforating veins is defined by the valve function of the venous valves and is unidirectional. The flow conditions thus directed prevent reflux from the deep into the superficial venous system during muscle contraction. A bidirectional, volatile blood flow is a typical finding in primary varicosis.

Up to 150 perforating veins can occur on the lower leg. Traditionally, the most important perforating veins have been given proper names. This nomenclature, which is listed here as an example, has now been largely abandoned:

Perforating veins of the foot

• Perforating veins of the ankle (3 medial PV - May/Kuster, 2-3 lateral PV)

Perforating veins of the lower leg

• PV of the medial lower leg:
• paratibial PV - Boyd, Sherman - connecting the main or lateral trunk of the V.saphena magna to the V.tibialis posterior
• posterior tibial PV - Cockett- usually 3 PV which are located at a distance of 6, 13.5 and 18.5 cm above the ankle joint. The entry point of the superior perforating vein at the lower edge of the soleus muscle is called the "soleus point". Another PV is called a "24 cm PV" because it is located about 24 cm above the sole of the foot.
• PV of the anterior lower leg: these connect the anterior inflows V.saphena magna with the V.tibialis anterior. They are located about 2.0-5.0 cm lateral to the tibial crest.
• PV of the lateral t ibia: these connect the lateral inflows V.saphena magna with the V.fibularis.
• PV of the posterior t ibia: of particular importance are the PV in the medial and lateral gastrocnemius region, the inermalleolar PV (May) and the paraachillary PV (Bassi). The perforating vein, named after Bassi, is a clinically significant PV between the saphenous and peroneal veins, about 5.0 cm above the calcaneal tuber.

Perforating veins of the thigh

• Of particular clinical interest are PV in the inguinal region and the femoral canal (named after Dodd ). These connect the vena saphena magna with the femoral vein. The so-called "mid-hunter-canal perorating vein", located about 16-20 cm above the edge of the patella, is considered clinically and functionally particularly important.

1. Joseph N et al (2016) A multicenter review of epidemiology and management of varicose veins for national guidance. Ann Med Surg (London) 8:21-27.
2. Mozes G et al (2004) New discoveries in anatomy and new terminology of leg veins: clinical implications.Vasc Endovascular Surg 38:367-374.
3. Ströbel P (2010) Anatomy and pathological anatomy of the epifascial venous system. In: T Noppeney, H Nüllen Diagnosis and therapy of varicosis. Springer Medicine Publishing House Heidelberg S 10 -31