Anatomical Classification of Incompetent Calf Perforator Veins; Ultrasound Analysis of Over 14,000 Individual Vessels.

IntroductionThe role of incompetent perforator veins (IPV) in venous pathology is controversial. It is generally accepted that they have a clinically significant impact in CEAP 6 cases as discussed by John Homans over a century ago. Previous studies of their anatomical distribution in the calf have been limited to cadaveric or clinical dissection and radiological imaging.MethodsWe present a large body of data and statistical analysis regarding the anatomical positions of calf IPV gathered over 19 years in a database maintained in a private vein clinic. This database contains 14,038 recorded individual IPV positions from 4531 patients. IPV positions were measured longitudinally in centimetres (cm) proximally from the medial or lateral malleoli. Transverse measurements were taken from the anterior tibial crest to produce a coordinate location for each IPV. These were then plotted to identify any visual clustering. These major clusters were then analysed using a density-based clustering algorithm OPTICS, to establish any specific, identifiable sub-clusters of IPVs.ResultsThe total number of individual patients was 4531. 960 were males and 3571 were female. There were 14,038 IPVs in 7108 limbs. Four major clusters were identified; medial, posteromedial, lateral and anterolateral. Further subdivision of these homogeneous groupings using the OPTICS algorithm failed to produce any evidence of sub-cluster separation.DiscussionThis study suggests that IPV locations in the calf are more widespread and homogeneous than traditionally accepted. Eponymous names do not appear valid and a new nomenclature is suggested.