Which Way Does Blood Flow in the Perforating Veins of the Leg?

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Abstract
There is controversy about the precise role of calf perforating veins in venous disease. Previous studies have shown that the direction of flow is principally inward and that outward flow may be used as a means of diagnosing perforator ‘incompetence’. Fifty-six perforating veins in 25 patients with clinical evidence of venous disease were examined using duplex ultrasound imaging. Only one perforating vein showed outward flow on distal compression of the limb, whereas local compression elicited outward flow in 38. Distal limb compression cannot be used to assess the ‘competence’ of calf perforating veins.