Journal «Angiology and Vascular Surgery» • 

2021 • VOLUME 27 • №2

Connection of perforating and intramuscular veins of the crus in varicosity

Sannikov A.B.1, Emelyanenko V.M.1, Solokhin S.A.2, Rachkov M.A.3, Drozdova I.V.4, Shaidakov E.V.5

1) Department of Additional Professional Education of Healthcare Specialists, Russian National Research Medical University named after N.I. Pirogov, Moscow,
2) Department of Laser Physics, Technological Academy named after V.A. Degtyarev, Kovrov, Vladimir Region,
3) Diagnostic Imaging Department, First Clinical Medical Centre, Kovrov, Vladimir Region,
4) Medical Centre «Palette», Vladimir,
5) Educational and Methodological Division, Institute of Human Brain named after N.P Bekhtereva, Russian Academy of Sciences, Saint Petersburg, Russia

Objective. This study was undertaken to investigate the clinical anatomy of indirect perforating veins and their connection to the intramuscular venous collector of the crus by means of MSCT phlebography.

Patients and methods. From 2015 till now, MSCT phlebography was used to examine a total of 400 patients with chronic diseases of lower limb veins. According to the CEAP classification, clinical class C0-C1 was present in 108 (27%) subjects, C2-C3 – in 173 (43.3%) patients, and C4-C6 – in 119 (29.7%) patients. All examinations were performed using a 128-slice multispiral CT scanner Philips Ingenuity, followed by 3D reconstruction with the help of the IntelliSpace Portal Image Editing Software package.

Results. In the 400 extremities examined, we identified a total of 11 655 indirect perforating veins of the calf. Studying the anatomical localization of perforating veins demonstrated that 3248 veins belonged to the posterior tibial group, 1830 veins – to the lateral group, 873 veins – to the paraachillary group, 276 veins – to the intergemellary group, 4451 veins – to the medial group, and 997 perforating veins – to the lateral group. 3D imaging made it possible to trace the entire course of the perforating veins originating from the posterior arched, intersaphenous, oblique veins or other communicating branches to the subfascial and intramuscular portions to the connection with the gastrocnemius and soleus veins which as the disease progresses undergo ectasia with the formation therein of pathological segmental hypervolemia.

Conclusion. Studying the ratio of the revealed indirect perforating veins of the determined groups and the presence of gradually developing ectasia of the intramuscular venous collectors in patients of various clinical classes from C0-C1 to C4-C6 made it possible to draw a conclusion on the involvement of perforating veins and intramuscular veins of the crus into the common pathohaemodynamic circle of the development and progression of chronic venous insufficiency in patients with varicose veins.

KEY WORDS: indirect perforating veins, MSCT phlebography, anatomical structures of lower-limb veins, intramuscular veins, varicose veins, chronic venous insufficiency.

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