Background: This study aims to emphasize the clinical significance of perforating vein insufficiency and to share our diagnosis and treatment experience for lower extremity perforating veins with insufficiency.

Methods: Thirty-six patients (19 males, 17 females; mean age 40.7±11.3 years; range 20 to 68 years) who underwent colored Doppler ultrasound (CDUS) assisted perforating vein ligation with mini-incision due to perforating vein insufficiency between December 2012 and December 2014 were retrospectively analyzed. Symptomatic patients having at least 350 milliseconds of venous reflux during Valsalva maneuver or perforating vein diameter greater than 4 mm in the erect position were included in the study. All affected limbs were classified according to the Clinical- Etiological-Anatomical-Pathophysiological classification system. According to Clinical-Etiological-Anatomical-Pathophysiological classification, 24 patients (66.7%) were C4 (Clinical class 4), five patients (13.9%) were C5, and seven patients (19.4%) were C6. Preoperative and postoperative venous clinical severity scores (VCSS) were calculated and compared. Patients were evaluated with CDUS at postoperative first week and third month.

Results: Mean perforating vein diameter was 4.43±0.35 mm (range 4.0 to 5.1 mm). No intraoperative complications occurred. No severe complications including infection, deep vein thrombosis, paresis, or paresthesia were observed postoperatively. While mean preoperative VCSS score was 12.25±3.6, postoperative VCSS score was 2.25±0.8 with a significant statistical difference (p≤0.05). Venous ulcer was detected in seven patients (19.4%). Mean diameter of venous ulcers was 30±15.2 mm (range 15 to 50 mm). All ulcers were healed postoperatively with a mean healing duration of 2.43±1.2 months.

< b>Conclusion: Colored Doppler ultrasound guided perforating vein ligation with mini-incision is an efficient, simple, and feasible procedure. Thus, it can be a safe alternative to current endovenous thermo-ablative techniques.

Keywords : Ligation; perforating vein; ultrasound; venous insufficiency