What is the direction of blood flow within the perforator/communicating veins?
From the superficial to the deep venous systems.
What is the sonographic hallmark pictorial appearance of the perforator veins that distinguishes them from the superficial and the deep venous systems?
Vertical or oblique orientation compared to the rest of the superficial and the deep venous systems.
What are some of the common lower limb perforator veins documented?
Inguinal ring perforators; Hunter perforators; Dodd perforators; Boyd perforators; Crockett perforators; Kustners and May perforators.
Predominantly vertically and near-vertical to obliquely oriented dilated vascular structures (perforators) are noted coursing into the deep subcutaneous tissues of the lower limbs right from the proximal thighs and downwards to the ankle joints resulting into superficial subcutaneous venous varicosities (measuring up to 3.7 mm in diameters; grade II-III) and subcutaneous tissue oedema bilaterally. The mentioned near vertically aligned vessels (perforators) involve the proximal thighs (Hunterian), distal thighs (Dodd), the popliteal fossae (Boyd), proximal, medial and distal calves (Cockett I, II & III) and the ankle joints (Kustners and May perforators).
In the erect position (exerted pressure) they measure up to 5.2 mm in diameter. A small (3.3 x 1.9 mm in diameter) hyperechoic and posteriorly shadowing focus (pointed with arrow) is noted at the right medial leg deep subcutaneous tissues along the variceal line consistent with a calcified thrombus. The bilateral long and shorter saphenous veins are moderately engorged as well demonstrating color aliasing on mapped out color flow study.