Perforator of the popliteal fossa and short saphenous vein insufficiency

Objectives: To assess the preoperative frequency of reflux from the perforator of the popliteal fossa (PPF) in cases of short saphenous vein insufficiency. Methods: Short saphenous vein insufficiency cases were carefully investigated in 590 consecutive patients affected by primary chronic venous insufficiency. PPF was identified in accordance with anatomical criteria translated in ultrasonic anatomy. Reflux was elicited in standing both by squeezing and active manoeuvres. Results: Short saphenous vein insufficiency occurred in 77/590 cases (13%). In 15/77 cases (19%) short saphenous insufficiency was fed by reflux from the PPF, with a competent saphenopopliteal junction, and this finding was confirmed at surgical exploration. PPF superficial outlet was found on the inferior aspect of the short saphenous main trunk (type 1 presentation, 11 cases) and on a varicous tributary (type 2, four cases). Conclusions: PPF is a neglected entity, but often is the only source of the reflux in the short saphenous vein system. The lack of preoperative awareness of its presence could lead to an increased rate of saphenopopliteal recurrences, especially in case of type 1 presentation.