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Prevalence and clinical significance of posterolateral thigh perforator vein incompetence.
J Vasc Surg 1997; 26(5):743-8JV

Abstract

PURPOSE

Posterolateral thigh perforator (PLTP) veins are part of the lateral thigh venous system, which in most people remains undeveloped. This study was designed to determine the prevalence and clinical significance of these veins.

METHODS

Over the past 6 years, 2820 lower limbs with signs and symptoms of chronic venous disease (CVD) were evaluated for venous reflux using color flow duplex imaging. Superficial, perforating, and deep veins were examined in the standing, sitting, and reversed Trendelenburg positions. PLTP veins were best identified in the standing position with the patient facing away from the examiner.

RESULTS

Twenty-six incompetent PLTP veins were found in 24 limbs (0.85%) of 21 patients (mean age, 43 +/- 16 years; range, 22 to 77 years). All PLTP veins pierced the fascia lata 12 to 25 cm (mean, 16 +/- 3 cm) above the popliteal skin crease in the lateral aspect of the thigh. At this level, the PLTP veins dove posteriorly 3 to 8 cm to join primarily tributaries of the deep femoral vein, superficial femoral vein, or both. Eight PLTP veins were duplicated at 1 to 2 cm below the fascia. Seven PLTP veins gave rise to superficial tributaries that were extended to the lower lateral and posterior thigh, whereas the remaining 19 PLTP veins gave rise to tributaries alongside the lesser saphenous vein and the anterior arch of the greater saphenous vein. On nine occasions, reflux was found in the PLTP veins and their associated tributaries alone. In all of these cases, reflux was adequately controlled with a tourniquet placed distal to the fascial defect. In the remaining 17 PLTP veins, reflux was also seen in the greater saphenous vein, the lesser saphenous vein, or both. None of the limbs that had PLTP vein reflux alone exceeded CVD class 3. When PLTP vein reflux was combined with saphenous reflux, there were five limbs classified as CVD class 4 and one limb each as CVD classes 5 and 6. Twenty limbs underwent ligation and stripping of the varicosities. Three of the earlier patients in the series underwent incomplete operations, which resulted in immediate residual varicosities from the PLTP tributaries. All three patients underwent reoperation successfully within a year.

CONCLUSIONS

The prevalence of PLTP vein reflux is quite low. Reflux in the PLTP veins alone is associated with mild to moderate clinical presentation. However, when it is combined with saphenous reflux skin damage can be present. Failure to recognize PLTP veins may result in an incomplete or unnecessary operation, leaving the patients with residual varicose veins.

Authors+Show Affiliations

Division of Vascular Surgery, Loyola University Medical Center, Maywood, Ill. 60153-3304, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9372810

Citation

Labropoulos, N, et al. "Prevalence and Clinical Significance of Posterolateral Thigh Perforator Vein Incompetence." Journal of Vascular Surgery, vol. 26, no. 5, 1997, pp. 743-8.
Labropoulos N, Delis K, Mansour MA, et al. Prevalence and clinical significance of posterolateral thigh perforator vein incompetence. J Vasc Surg. 1997;26(5):743-8.
Labropoulos, N., Delis, K., Mansour, M. A., Kang, S. S., Buckman, J., Nicolaides, A. N., & Baker, W. H. (1997). Prevalence and clinical significance of posterolateral thigh perforator vein incompetence. Journal of Vascular Surgery, 26(5), pp. 743-8.
Labropoulos N, et al. Prevalence and Clinical Significance of Posterolateral Thigh Perforator Vein Incompetence. J Vasc Surg. 1997;26(5):743-8. PubMed PMID: 9372810.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence and clinical significance of posterolateral thigh perforator vein incompetence. AU - Labropoulos,N, AU - Delis,K, AU - Mansour,M A, AU - Kang,S S, AU - Buckman,J, AU - Nicolaides,A N, AU - Baker,W H, PY - 1997/12/31/pubmed PY - 1997/12/31/medline PY - 1997/12/31/entrez SP - 743 EP - 8 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 26 IS - 5 N2 - PURPOSE: Posterolateral thigh perforator (PLTP) veins are part of the lateral thigh venous system, which in most people remains undeveloped. This study was designed to determine the prevalence and clinical significance of these veins. METHODS: Over the past 6 years, 2820 lower limbs with signs and symptoms of chronic venous disease (CVD) were evaluated for venous reflux using color flow duplex imaging. Superficial, perforating, and deep veins were examined in the standing, sitting, and reversed Trendelenburg positions. PLTP veins were best identified in the standing position with the patient facing away from the examiner. RESULTS: Twenty-six incompetent PLTP veins were found in 24 limbs (0.85%) of 21 patients (mean age, 43 +/- 16 years; range, 22 to 77 years). All PLTP veins pierced the fascia lata 12 to 25 cm (mean, 16 +/- 3 cm) above the popliteal skin crease in the lateral aspect of the thigh. At this level, the PLTP veins dove posteriorly 3 to 8 cm to join primarily tributaries of the deep femoral vein, superficial femoral vein, or both. Eight PLTP veins were duplicated at 1 to 2 cm below the fascia. Seven PLTP veins gave rise to superficial tributaries that were extended to the lower lateral and posterior thigh, whereas the remaining 19 PLTP veins gave rise to tributaries alongside the lesser saphenous vein and the anterior arch of the greater saphenous vein. On nine occasions, reflux was found in the PLTP veins and their associated tributaries alone. In all of these cases, reflux was adequately controlled with a tourniquet placed distal to the fascial defect. In the remaining 17 PLTP veins, reflux was also seen in the greater saphenous vein, the lesser saphenous vein, or both. None of the limbs that had PLTP vein reflux alone exceeded CVD class 3. When PLTP vein reflux was combined with saphenous reflux, there were five limbs classified as CVD class 4 and one limb each as CVD classes 5 and 6. Twenty limbs underwent ligation and stripping of the varicosities. Three of the earlier patients in the series underwent incomplete operations, which resulted in immediate residual varicosities from the PLTP tributaries. All three patients underwent reoperation successfully within a year. CONCLUSIONS: The prevalence of PLTP vein reflux is quite low. Reflux in the PLTP veins alone is associated with mild to moderate clinical presentation. However, when it is combined with saphenous reflux skin damage can be present. Failure to recognize PLTP veins may result in an incomplete or unnecessary operation, leaving the patients with residual varicose veins. SN - 0741-5214 UR - https://www.unboundmedicine.com/medline/citation/9372810/Prevalence_and_clinical_significance_of_posterolateral_thigh_perforator_vein_incompetence_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(97)70085-5 DB - PRIME DP - Unbound Medicine ER -