Advances in diagnosis and treatment of pathologic perforating veins

Abstract:

Perforating veins connect the deep and superficial venous systems of the lower extremities and play a crucial role in maintaining unidirectional blood flow from the superficial to the deep veins. Incompetence of perforating vein valves may result in reflux from the deep to the superficial venous system, leading to elevated superficial venous pressure and subsequent pathological changes, including varicose veins, skin pigmentation, dermatitis, and venous ulcers. Accumulating evidence suggests that pathological perforating veins (PPVs) are closely associated with the development and delayed healing of lower extremity venous ulcers and represent an important contributor to postoperative recurrence of varicose veins. However, whether routine concomitant treatment of perforating veins provides additional clinical benefits in patients primarily treated for superficial venous reflux remains controversial. With advances in imaging techniques and minimally invasive therapies, diagnostic accuracy and treatment options for PPVs have expanded substantially. This review summarizes the current understanding of the pathophysiology, anatomical characteristics, diagnostic approaches, and therapeutic advances in PPVs, aiming to provide clearer guidance for clinical decision-making and individualized management.