What can go wrong with perforator veins
As outlined in the previous section (‘where are perforating veins?‘), perforating veins should take venous blood from the superficial veins to the deep veins where it can be pumped back to the heart and lungs.
If the valves in the perforating veins fail, then the perforating veins become “incompetent”, and therefore are called incompetent perforating veins (IPVs). These really only have a major effect when the leg muscle is being activated during walking or exercise, which should normally pump blood back to the heart but instead blood is pumped from the deep veins under pressure back through the incompetent perforating veins (IPVs) causing inflammation and damage in the superficial veins and tissues. This is a problem of what is called “active phase reflux”. To understand this more fully, please see the College of Phlebology textbook “Understanding Venous Reflux – the Cause of Varicose Veins and Venous Leg Ulcers“.
What clinical problems can incompetent perforating veins (IPVs) cause?
Although incompetent perforating veins (IPVs) are small in diameter, the blood pumped out of them during active phase reflux is at a very high pressure and velocity. As such, the effects of these jets of blood when they hit the superficial veins can be seen in several different ways:
• varicose veins (especially recurrent varicose veins)
• red patches
• brown patches
Because perforating veins are small and difficult to treat, the majority of doctors still do not look for incompetent perforating veins nor treat incompetent perforating veins as part of their treatment of varicose veins or the other venous conditions listed above.
As such, it is not surprising that incompetent perforating veins are far more common in people with recurrent varicose veins and several recent studies have pointed out that incompetent perforating veins are one of the major causes of recurrent varicose veins after vein surgery. If the incompetent perforating veins were treated as part of the vein surgery routinely, the results of venous surgery (whether for varicose veins or for other venous conditions) is likely to be far more successful.
In the past the treatments for perforator veins have been difficult or destructive and, with the difficulties in diagnosing them in the first place, there has been a lack of enthusiasm for doctors to treat them. However with the new techniques that have been developed for the treatment of incompetent perforating veins, treatments can be performed easily with minimally invasive techniques under local anaesthetic. As such the investigation and treatment of incompetent perforating veins should now be routine by any true venous expert and any dedicated vein clinic.