Geza Mozes, MD, Peter Gloviczki, MD, Sunil S. Menawat, MD, Dean R

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Presentation transcript:

Surgical anatomy for endoscopic subfascial division of perforating veins Geza Mozes, MD, Peter Gloviczki, MD, Sunil S. Menawat, MD, Dean R. Fisher, BS, Stephen W. Carmichael, PhD, DSc, Anna Kadar, MD, PhD, DSc Journal of Vascular Surgery Volume 24, Issue 5, Pages 800-808 (November 1996) DOI: 10.1016/S0741-5214(96)70016-2 Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Relationship of superficial, perforating, and deep venous systems to the fascia of the superficial posterior compartment. Note that Cockett III and lowest proximal paratibial perforator (“24-cm perforator”) are readily accessible from the subfascial space. Journal of Vascular Surgery 1996 24, 800-808DOI: (10.1016/S0741-5214(96)70016-2) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Number and location of 287 medial direct PVs in 40 legs. Distance of perforators from medial malleolus was corrected for differences in leg length. Journal of Vascular Surgery 1996 24, 800-808DOI: (10.1016/S0741-5214(96)70016-2) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Superficial and perforating veins in the medial side of the leg (cross-sections at levels A through D are shown in Fig. 4) . Journal of Vascular Surgery 1996 24, 800-808DOI: (10.1016/S0741-5214(96)70016-2) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Compartments and medial veins of leg. Cross sections at level of Cockett II (A), Cockett III (B), “24-cm” (C), and more proximal paratibial (D) PVs. GSV, Greater saphenous vein; PAV, posterior arch vein; PTVs, posterior tibial veins; SPC, superficial posterior compartment; CII, Cockett II, CIII, Cockett III; PTP, paratibial perforator. Journal of Vascular Surgery 1996 24, 800-808DOI: (10.1016/S0741-5214(96)70016-2) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Compartments and medial veins of leg. Cross sections at level of Cockett II (A), Cockett III (B), “24-cm” (C), and more proximal paratibial (D) PVs. GSV, Greater saphenous vein; PAV, posterior arch vein; PTVs, posterior tibial veins; SPC, superficial posterior compartment; CII, Cockett II, CIII, Cockett III; PTP, paratibial perforator. Journal of Vascular Surgery 1996 24, 800-808DOI: (10.1016/S0741-5214(96)70016-2) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Compartments and medial veins of leg. Cross sections at level of Cockett II (A), Cockett III (B), “24-cm” (C), and more proximal paratibial (D) PVs. GSV, Greater saphenous vein; PAV, posterior arch vein; PTVs, posterior tibial veins; SPC, superficial posterior compartment; CII, Cockett II, CIII, Cockett III; PTP, paratibial perforator. Journal of Vascular Surgery 1996 24, 800-808DOI: (10.1016/S0741-5214(96)70016-2) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Compartments and medial veins of leg. Cross sections at level of Cockett II (A), Cockett III (B), “24-cm” (C), and more proximal paratibial (D) PVs. GSV, Greater saphenous vein; PAV, posterior arch vein; PTVs, posterior tibial veins; SPC, superficial posterior compartment; CII, Cockett II, CIII, Cockett III; PTP, paratibial perforator. Journal of Vascular Surgery 1996 24, 800-808DOI: (10.1016/S0741-5214(96)70016-2) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Cross-section of upper third of leg. Note paratibial PV passing between periosteum of tibia and fascia of superficial posterior compartment. Veins were filled with blue latex. PTP, Paratibial perforator; PTVs, posterior tibial veins. Journal of Vascular Surgery 1996 24, 800-808DOI: (10.1016/S0741-5214(96)70016-2) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Number and location of 228 indirect muscle PVs on medial side of 40 legs. Distance of perforators from medial malleolus was corrected for differences in leg length. Journal of Vascular Surgery 1996 24, 800-808DOI: (10.1016/S0741-5214(96)70016-2) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Corrosion cast of medial superficial and perforating veins of right leg. A, Skin and portion of subcutaneous fat were removed. B, Fascia has been incised and rolled anteriorly to expose superficial posterior compartment. Note that only lower paratibial perforator and Cockett III perforators are now accessible. Arrowheads show veins draining lower part of soleus into posterior tibial vein. MP , Muscle perforator, PTP , paratibial perforator; CII , Cockett II; CIII , Cockett III. Journal of Vascular Surgery 1996 24, 800-808DOI: (10.1016/S0741-5214(96)70016-2) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Corrosion cast of medial superficial and perforating veins of right leg. A, Skin and portion of subcutaneous fat were removed. B, Fascia has been incised and rolled anteriorly to expose superficial posterior compartment. Note that only lower paratibial perforator and Cockett III perforators are now accessible. Arrowheads show veins draining lower part of soleus into posterior tibial vein. MP , Muscle perforator, PTP , paratibial perforator; CII , Cockett II; CIII , Cockett III. Journal of Vascular Surgery 1996 24, 800-808DOI: (10.1016/S0741-5214(96)70016-2) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions