Calf Perforating Veins – Time for an Objective Appraisal?

Most incompetent calf perforating veins are found in association with superficial venous reflux

“…6 However, the benefits of SEPS over and above those of saphenous surgery alone are yet to be demonstrated and so the clear indications for surgical interruption of incompetent medial calf perforating veins (IPVs) are as yet undefined. [9][10][11] Saphenous surgery alone has been demonstrated to correct perforator physiology in the absence of deliberate intervention aimed at these vessels in patients without deep system reflux. 12,13 The median diameters of the medial calf perforating veins were also seen to decrease after saphenous Most incompetent calf perforating veins are found in association with superficial venous reflux Bothell, Wash).…”

Saphenous surgery does not correct perforator incompetence in the presence of deep venous reflux

“…7 Although the feasibility, safety, and early efficacy of SEPS has been confirmed by reports from both Europe 8 and North America, 9 and the significant advantages SEPS has over Linton's procedure have been clearly demonstrated, 10 the indications for this operation remain controversial. 11,12 Uncontrolled data support the contention that, in the presence of isolated superficial venous reflux, saphenous surgery comprising sapheno-femoral ligation, stripping of the long saphenous vein in the thigh, and multiple phlebectomies or sapheno-popliteal ligation and multiple phlebectomies, as indicated, promotes healing and Saphenous surgery does not correct perforator incompetence in the presence of deep venous reflux reduces recurrence of chronic venous ulceration. 13,14 However, most patients with venous ulceration have deep venous reflux, either in isolation or in combination with superficial reflux, together with more dilated medial calf perforating veins permitting outward pathological flow.…”

The relationship between the number, competence, and diameter of medial calf perforating veins and the clinical status in healthy subjects and patients with lower-limb venous disease

“…[1][2][3] However, the benefits of venous surgery in patients with deep venous disease are much less certain, and, in particular, the value of interrupting incompetent perforating veins (IPVs) on the medial aspect of the calf in an attempt to protect the skin of the gaiter area from excessively high deep venous pressures remains unproved. [4][5][6] Because of the high incidence of wound-related complications, open perforator ligation (Linton's and Cockett's procedures) has largely been abandoned, despite some evidence that the operation might be beneficial in patients with popliteal vein reflux who have a poor prognosis. 7 More recently, interest in perforator surgery has been reawakened by the ability to locate precisely medial calf perforators with color-flow duplex ultrasound scanning…”