Ann Phlebology.  2023 Dec;21(2):95-98. 10.37923/phle.2023.21.2.95.

Pretibial Varicose Vein from Intraosseous Perforating Vein Incompetence

• Yoon Y

• KMID: 2549988
• DOI: http://doi.org/10.37923/phle.2023.21.2.95

Abstract

Objective
Most causes of lower extremity varicose veins are associated with saphenous veins. However, there are several unusual causes of varicose veins that are not related to the saphenous veins. This study reports rare cases of varicose veins originating from intraosseous perforating vein incompetence. The purpose of this study is to examine the clinical manifestations, diagnostic methods, and appropriate treatments.
Methods
A total of 5,481 patients with lower extremity varicose veins visited our clinic from June 2016 to October 2021. Among them, seven patients were identified to have intraosseous perforating vein incompetence. Color Doppler ultrasound was performed to diagnose reflux at the site of the perforating vein through the tibial cortex.
Results
Varicose veins were observed in the pretibial area, and they were connected to the tibial perforating vein with venous reflux. The patients experienced common symptoms associated with lower extremity varicose veins, such as heaviness, cramping, tingling, swelling and discomfort. However, in our cases, there were no localized symptoms specifically related to the tibia area. The surgical procedure performed involved perforating vein ligation and phlebectomy with an incision under local anesthesia.
Conclusion
Intraosseous perforating vein incompetence is a very rare cause of pretibial varices, primarily observed on the anteromedial side of the mid-shaft of the tibia. It is easily overlooked due to its rarity. However, with sufficient knowledge, intraosseous perforating vein incompetence can be accurately diagnosed using Doppler ultrasound alone, and it can be easily treated through perforating vein ligation and phlebectomy.

Keyword

Varicose vein; Intraosseous perforating vein; Pretibial varices