ABSTRACT
This chapter reviews the relevant surgical anatomy of perforating veins, the evidence to support the contribution of incompetent perforating veins to the pathophysiology of chronic venous disorders, and the techniques and results of both open and endoscopic perforator ablation. Incompetent perforating veins were first linked to chronic venous insufficiency (CVI) and it’s most severe manifestation, venous ulceration, nearly one and a half centuries ago by John Gay. There is a consensus of opinion that venous hypertension in the erect position and during ambulation is the most important factor responsible for the development of skin changes and venous ulceration in CVI. The presence of incompetent perforators in patients with advanced CVI and low operative risk constitutes a potential indication for surgical intervention. The need for perforator interruption remains a subject of debate, as the significance of incompetent perforating veins and their contribution to the severity of CVI remains in question.
