title: Anomalous intraosseous venous drainage: Bone perforators?
abstract: Objectives Anomalous intraosseous venous drainage is a rare and almost unknown entity; only 14 cases have been reported in the literature and 4 mentioned in textbooks. We report the characteristics of 35 further cases observed in 32 patients. Method After the presentation of two cases at the congress of the French Society of Phlebology in Paris (2013), 12 colleagues joined to present a large series of so-called bone perforators observed in their practice, all identified with at least a duplex investigation. Results Thirty-two patients suffering from varicose veins and/or skin changes (C2-C6) associated with a bone perforator of the tibia (with bilateral anomalies in three) are reported: 19 females and 13 males, average age 56.9. The majority of the affected legs were symptomatic (30/35). Bone perforator was an isolated finding in 27/35 legs. In three cases, the investigations revealed that the venous reflux in the bone originated from an incompetent posterior tibial vein. Conclusions We suggest the name of "bone perforators" for an anomalous tibial intraosseous venous drainage, feeding varicose veins, and in more advanced stages lipodermatosclerosis and leg ulcers. Most of them were successfully treated with surgery or sclerotherapy.
authors.affiliation: 1 Department of Dermatology, Inselspital, Bern, Switzerland.
authors.forename: Albert-Adrien
authors.initials: AA
authors.lastname: Ramelet
authors.affiliation: 2 Clinique du Millénaire, Montpellier (France).
authors.forename: Vincent
authors.initials: V
authors.lastname: Crebassa
authors.affiliation: 3 Sanatorio Mater Dei, Buenos-Aires City, Argentine.
authors.forename: Carlos
authors.initials: C
authors.lastname: D Alotto
authors.affiliation: 3 Sanatorio Mater Dei, Buenos-Aires City, Argentine.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Buero
authors.affiliation: 4 Private office, Bourgoin-Jallieu, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Gillet
authors.affiliation: 5 Espace Artois Santé, Arras, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Grenot-Mercier
authors.affiliation: 6 Venenzentrum, Bad Ragaz, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Küpfer
authors.affiliation: 7 Venenpraxis, Wunstorf, Germany.
authors.forename: Erika
authors.initials: E
authors.lastname: Mendoza
authors.affiliation: 8 Private office, Alençon, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Monsallier
authors.affiliation: 9 Institute of Functional Phlebologic Surgery, Karl Landsteiner Society, Melk, Austria.
authors.forename: Alfred
authors.initials: A
authors.lastname: Obermayer
authors.affiliation: 10 Consultório Médico Angiologia, Rio de Janeiro, Brasil.
authors.forename: Kenedy
authors.initials: K
authors.lastname: Pacheco
authors.affiliation: 11 Service de Médecine Vasculaire, CHU Rangueil Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Pros
authors.affiliation: 12 Private office, Grenoble, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Rastel
authors.affiliation: 13 Private office, Melun, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Soulié
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001847:Bone Diseases / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013977:Tibia / Q000098:blood supply / Q000473:pathology; D014648:Varicose Veins / Q000473:pathology / Q000628:therapy
keywords: Anomalous intraosseous venous drainage; bone perforators; chronic venous disorders; perforator; tibia