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Rather than describing a perforating vein whose situation is
not always as precise and as constant as that described by the
author after whom it is named,. it is preferable to define groups
of perforating veins (Figures 57 and 58). In general, only one
structure of these groups of veins will become pathologically
enlarged.
The essential groups of perforating veins are:
proximal terminal
perforating veins (A) which connect the femoral vein with
the terminal portion of the long saphenous vein or its accessory
veins (upper third of the thigh);
perineal perforating
veins (B) which connect latero-uterine and ovarian veins
of the hypogastric network with branches of the long saphenous
trunk and its posterior branches, or with the short saphenous
network via a Giacomini vein;
distal terminal
perforating veins (C) which connect the femoral vein to
the long saphenous network in the middle third of the thigh
(main trunk, its accessory veins or tributaries);
Dodd's perforating
veins or perforating veins of the adductor canal (D) ) which
connect the femoral vein to the long saphenous network in the
lower third of the thigh (main trunk, its accessory veins or
tributaries);
Boyd's perforating
veins (E), form a communication between the saphenous network
of the subcondylar region of the leg and the popliteal or tibioperoneal
trunks;
medial gastrocnemius
perforating veins (F) which communicate between the intramuscular
veins of the medial head of the gastrocnemius muscle and the
saphenous network of the leg (main trunk, calf plexus, posterior
branches). These perforating veins sometimes represent an indirect
communication with the short saphenous system, for example via
the lower pole vein which travels in the medial head of the
gastrocnemius muscle;
Cockett's perforating
veins (G) between posterior tibial veins and posterior saphenous
branches, especially Leonardo da Vinci's vein;
peroneal perforating
veins (H) connecting the peroneal veins to the anterior
saphenous branches;
perforating
veins of the retromalleolar and submalleolar regions (I)
forming a bridge between plantar veins and saphenous and marginal
branches.
From a pathophysiological point of view, the development of
skin lesions is all the more probable, frequent, and severe
when the perforating veins involved are situated more distally.
Perforating veins of the thigh are usually incriminated in posttreatment
recurrences, Boyd's perforators are involved in the development
of varicosities after treatment, medial gastrocnemius perforating
veins are responsible for extensive thromboses, and finally,
Cockett's perforators are involved in trophic disorders of the
skin.
Further reading
Dodd H., Cockett F.B. The pathology and surgery of the veins of the lower limb.
Churchill Livingstone Ed., 2nd Edition, 1976.
Van Limborgh J., Banga D.A., Meijerniks C. Démonstration d'un modèle
anatomique des veines de l'extrémité inférieure. Phlébologie
1961; 14: 175.
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