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The nonsaphenous vein of the popliteal fossa: prevalence, patterns of reflux, hemodynamic quantification, and clinical significance.

Abstract

BACKGROUND

A large tortuous vein coursing over the posterior aspect of the knee and the upper calf may give rise to a constellation of varicose veins unrelated to the great (GSV) or small (SSV) saphenous veins. Designated the popliteal fossa vein (PFV), it perforates the deep popliteal fascia and empties into the deep system. We examined the prevalence, anatomic reflux patterns, hemodynamic role, and clinical significance of the PFV.

METHODS

We examined 543 patients (818 limbs) with venous disease, aged 14 to 94 years (median, 55 years). The study consisted of group A, comprising limbs with a PFV, and group B, formed by the remaining limbs. The history, clinical examination, and venous duplex scan findings were analyzed retrospectively. Venous clinical severity and venous segmental disease scores of group A were compared with those of an equal number of CEAP-, sex-, and age-matched control limbs. In situ venous hemodynamics of the PFV obtained with duplex scan are reported.

RESULTS

A PFV was found in 24 (2.93%) of 818 limbs (95% confidence interval [CI], 1.8%-4.1%); 24 (4.4%) of 543 subjects (95% CI, 2.7%-6.2%), 12 men and 12 women aged 23 to 82 years (median, 54 years) had a PFV. CEAP clinical classes in limbs with a PFV were as follows: C2, 15 limbs; C3, 5 limbs; C4, 2 limbs; C5, 1 limb; and C6, 1 limb. Proximal and distal (92%), superficial (100%), perforator (87.5%), and complex-pattern (41.7%) reflux occurred more often in group A (P < .01). Incompetence in the GSV (75%), posterior arch, and posteromedial and saphenous tributaries was also more frequent in group A (P < .05). SSV reflux in group A (29%) matched that in group B. The PFV terminated at the deep system (96% in the popliteal vein) above the SSV (median distance, 1.5 cm; 95% CI, 0.5-2 cm). The odds ratio for a PFV in limbs with prior SSV disconnection was 5.68. Deep reflux was evenly distributed in group A (41.7%) and group B (27%). The prevalence of incompetent perforators was 283% (95% CI, 194%-373%) in group A and 96% (95% CI, 95%-98%) in group B (P < .001). PFV tributaries were distributed at the popliteal area (100%); the posterior (87.5%), medial (62.5%), and lateral (37.5%) upper calf; and the posterior distal thigh (17%), often projecting to the posterior GSV arch (50%). The (median) peak velocity of reflux in the PFV was 82.6 cm/s, the mean velocity was 17.7 cm/s, the duration was 2.4 seconds, the volume flow was 231.5 mL/min, and the expelled volume was 9.3 mL. The median diameter of the PFV at the crossing of the fascia was 0.527 cm. Venous clinical severity (range, 2-17; median, 5.5) and venous segmental disease (range, 0.5-8; median, 2.75) scores in limbs with a PFV exceeded (P <or= .04) those of the control limbs.

CONCLUSIONS

With a prevalence of 4.4%, the PFV presents in limbs featuring complex reflux patterns involving all three venous systems proximally and distally. Limbs with a PFV have a higher propensity for GSV and superficial tributary reflux and have perforator vein incompetence three times more often than limbs without this vein. The PFV perforates the deep popliteal fascia terminating at the deep system (ie, the popliteal vein in 96%) distinctly above the SSV. In light of its reflux dynamics, nearing or exceeding those of severely impaired perforator veins, and the complex patterns of reflux (venous segmental disease) and venous clinical severity (high venous clinical severity scores) of the affected limbs, clinical and investigational awareness of the PFV is warranted.

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  • Authors+Show Affiliations

    ,

    St Mary's Hospital, London, United Kingdom. k.delis@ic.ac.uk

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    Source

    Journal of vascular surgery 44:3 2006 Sep pg 611-9

    MeSH

    Adult
    Aged
    Aged, 80 and over
    Cross-Sectional Studies
    Female
    Hemodynamics
    Humans
    Knee
    Leg
    Male
    Middle Aged
    Popliteal Vein
    Saphenous Vein
    Ultrasonography, Doppler, Color
    Varicose Veins

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    16950443

    Citation

    Delis, Konstantinos T., et al. "The Nonsaphenous Vein of the Popliteal Fossa: Prevalence, Patterns of Reflux, Hemodynamic Quantification, and Clinical Significance." Journal of Vascular Surgery, vol. 44, no. 3, 2006, pp. 611-9.
    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(3):611-9.
    Delis, K. T., Knaggs, A. L., Hobbs, J. T., & Vandendriessche, M. A. (2006). The nonsaphenous vein of the popliteal fossa: prevalence, patterns of reflux, hemodynamic quantification, and clinical significance. Journal of Vascular Surgery, 44(3), pp. 611-9.
    Delis KT, et al. The Nonsaphenous Vein of the Popliteal Fossa: Prevalence, Patterns of Reflux, Hemodynamic Quantification, and Clinical Significance. J Vasc Surg. 2006;44(3):611-9. PubMed PMID: 16950443.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The nonsaphenous vein of the popliteal fossa: prevalence, patterns of reflux, hemodynamic quantification, and clinical significance. AU - Delis,Konstantinos T, AU - Knaggs,Alison L, AU - Hobbs,John T, AU - Vandendriessche,Marianne A, PY - 2005/12/18/received PY - 2006/04/28/accepted PY - 2006/9/5/pubmed PY - 2006/10/25/medline PY - 2006/9/5/entrez SP - 611 EP - 9 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 44 IS - 3 N2 - BACKGROUND: A large tortuous vein coursing over the posterior aspect of the knee and the upper calf may give rise to a constellation of varicose veins unrelated to the great (GSV) or small (SSV) saphenous veins. Designated the popliteal fossa vein (PFV), it perforates the deep popliteal fascia and empties into the deep system. We examined the prevalence, anatomic reflux patterns, hemodynamic role, and clinical significance of the PFV. METHODS: We examined 543 patients (818 limbs) with venous disease, aged 14 to 94 years (median, 55 years). The study consisted of group A, comprising limbs with a PFV, and group B, formed by the remaining limbs. The history, clinical examination, and venous duplex scan findings were analyzed retrospectively. Venous clinical severity and venous segmental disease scores of group A were compared with those of an equal number of CEAP-, sex-, and age-matched control limbs. In situ venous hemodynamics of the PFV obtained with duplex scan are reported. RESULTS: A PFV was found in 24 (2.93%) of 818 limbs (95% confidence interval [CI], 1.8%-4.1%); 24 (4.4%) of 543 subjects (95% CI, 2.7%-6.2%), 12 men and 12 women aged 23 to 82 years (median, 54 years) had a PFV. CEAP clinical classes in limbs with a PFV were as follows: C2, 15 limbs; C3, 5 limbs; C4, 2 limbs; C5, 1 limb; and C6, 1 limb. Proximal and distal (92%), superficial (100%), perforator (87.5%), and complex-pattern (41.7%) reflux occurred more often in group A (P < .01). Incompetence in the GSV (75%), posterior arch, and posteromedial and saphenous tributaries was also more frequent in group A (P < .05). SSV reflux in group A (29%) matched that in group B. The PFV terminated at the deep system (96% in the popliteal vein) above the SSV (median distance, 1.5 cm; 95% CI, 0.5-2 cm). The odds ratio for a PFV in limbs with prior SSV disconnection was 5.68. Deep reflux was evenly distributed in group A (41.7%) and group B (27%). The prevalence of incompetent perforators was 283% (95% CI, 194%-373%) in group A and 96% (95% CI, 95%-98%) in group B (P < .001). PFV tributaries were distributed at the popliteal area (100%); the posterior (87.5%), medial (62.5%), and lateral (37.5%) upper calf; and the posterior distal thigh (17%), often projecting to the posterior GSV arch (50%). The (median) peak velocity of reflux in the PFV was 82.6 cm/s, the mean velocity was 17.7 cm/s, the duration was 2.4 seconds, the volume flow was 231.5 mL/min, and the expelled volume was 9.3 mL. The median diameter of the PFV at the crossing of the fascia was 0.527 cm. Venous clinical severity (range, 2-17; median, 5.5) and venous segmental disease (range, 0.5-8; median, 2.75) scores in limbs with a PFV exceeded (P <or= .04) those of the control limbs. CONCLUSIONS: With a prevalence of 4.4%, the PFV presents in limbs featuring complex reflux patterns involving all three venous systems proximally and distally. Limbs with a PFV have a higher propensity for GSV and superficial tributary reflux and have perforator vein incompetence three times more often than limbs without this vein. The PFV perforates the deep popliteal fascia terminating at the deep system (ie, the popliteal vein in 96%) distinctly above the SSV. In light of its reflux dynamics, nearing or exceeding those of severely impaired perforator veins, and the complex patterns of reflux (venous segmental disease) and venous clinical severity (high venous clinical severity scores) of the affected limbs, clinical and investigational awareness of the PFV is warranted. SN - 0741-5214 UR - https://www.unboundmedicine.com/medline/citation/16950443/The_nonsaphenous_vein_of_the_popliteal_fossa:_prevalence_patterns_of_reflux_hemodynamic_quantification_and_clinical_significance_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(06)00823-8 DB - PRIME DP - Unbound Medicine ER -