Jan Sloves: Medial Thigh Perforators – The Veins We Keep Missing
Jan Sloves, President and Consultant at Vascular Imaging Professionals LLC, shared a post on LinkedIn about a recent article by Gabriela Hnatkova et al., published in JVS – VL:
“Medial Thigh Perforators: The Veins We Keep Missing
A new JVSVL paper mapped 371 medial thigh perforators in 306 limbs – and it quietly challenges how we decide which perforators matter in chronic venous disease.
The headline finding: diameter alone is not the decision‑maker.
Multiple perforators with a lumen less than 3.5 mm still showed reflux more than 0.5 s and acted as independent sources of superficial reflux, contributing to progression and recurrence.
That sits uneasily next to guideline language that still leans on greater than or equal to 3.5 mm at the fascia plus reflux as the classic definition of ‘insufficient.’
The authors also demonstrate how densely clustered these perforators are along the medial thigh, how often they connect to non‑GSV suprafascial veins, and how foam sclerotherapy echocontrast suddenly reveals a subfascial network that routine duplex simply does not show.
By the time we label a case ‘recurrent varicosities,’ these perforators have often been part of the story all along.
For anyone scanning or treating CVD, the practical messages are simple: deliberately search the medial thigh in defined zones, not just ‘around’ the GSV; document perforator connections and reflux pattern, not only diameter; expect that standard mapping underestimates the true communication network sustaining reflux.
I’m curious how this aligns with your practice: are sub‑3.5 mm perforators with clear reflux already on your treatment radar, or do size cut‑offs still dominate your decision‑making?
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Title: The anatomical conditions of the venous perforators of the medial side of the thigh in progressive chronic venous disease
Auhtors: Gabriela Hnatkova, Lukas Hnatek, David Kachlik
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