Ultrasonographical features of atypical perforator vascular bundles in the popliteal region

BACKGROUND: Phlebological diseases are widespread around the globe, which requires precise knowledge of venous anatomy and pathology from the physicians, especially in difficult cases. This study aimed to determine the ultrasonographical (US) features of atypical perforator vascular bundles in the popliteal region in patients with varicose veins (VVs).METHODS: This prospective study included 2320 patients with VVs, clinical manifestation C2-C3 (CEAP classification). We identified 34 subjects (19 males, 15 females; 45.18±12.1 years of age) with atypical popliteal perforator veins (PV). Ultrasound imaging was used to assess structural and functional properties of perforator units (bundles). All patients underwent open vascular procedures on atypical PVs.RESULTS: The overall incidence of atypical popliteal PV in patients with VVs was 1.47%. Among these, we identified isolated PV insufficiency in 94% of cases with intact saphenous veins, and in 93.75% of cases we detected concomitant deep venous valvular incompetence, including common femoral vein (CFV), femoral vein, and popliteal vein (PopV) incompetence in 73% of cases, as well as CFV, deep femoral vein, and PopV incompetence in 27% of cases. In 96.9% of cases PV formed a confluence with the PopV 1.5±0.2 cm above the level of the knee. The subfascial segment of the PV was 4.4±0.48 cm long. Intraoperatively, we identified an arterial branch as a part of perforator bundle originating from the popliteal artery.CONCLUSIONS: The occurrence of atypical perforator bundles in the popliteal region is rare reaching 1.47% in subjects with varicose veins.