Anatomy of the Superficial, Deep, and Perforator veins of the foot: Essential Insights for Interventional Radiologists in Deep Venous Arterialization

Understanding the foot venous complex is essential for assessing the deep venous arterialization circuit during procedures. By clarifying the connections between superficial and deep veins and their perforators, practitioners can enhance strategies to promote optimal blood flow toward wounds, both intra-procedurally and in cases of non-maturation post-procedure.

Background:  

The foot's venous anatomy features pathways that can redirect flow from the distal pedal loop to the proximal region.  Rapid diversion of arterialized blood into the central venous return may compromise pedal loop arterialized perfusion.












Clinical Findings/Procedure Details:

The foot's venous system includes superficial, deep, and perforating veins. Superficial veins consist of the medial and lateral marginal veins on the dorsum, arising from the first intermetatarsal perforator vein. The medial marginal vein drains into the great saphenous vein, while the lateral marginal vein connects to the small saphenous vein.

Deep veins include the lateral and medial plantar veins, which drain into the common plantar and paired posterior tibial veins, along with paired dorsalis pedis veins leading to the anterior tibial veins. Dorsalis pedis veins connect to the superficial system via the anteromedial and anterolateral malleolar veins, with the first metatarsal interspace perforator linking the dorsal venous arch to the deep plantar system.

Perforator veins connecting the medial marginal vein and medial plantar vein include the malleolar, navicular, and cuneiform perforators. On the lateral side, the intertendinous and subtendinous perforators merge into a trunk that integrates with the lateral marginal network, forming the main trunk for the small saphenous vein. The calcaneal perforator vein directly connects the lateral plantar veins to the small saphenous vein.

The optimal flow pathway for deep venous arterialization is from the lateral plantar vein through the first metatarsal perforator to the dorsal outflow. A suboptimal pathway occurs when blood moves from the lateral plantar vein to the dorsal outflow before reaching the first metatarsal perforator.

 

Conclusion and/or Teaching Points:

Understanding these venous dynamics can help address the non-focalization of oxygenated blood flow to wound areas caused by undesired flow through perforators and superficial veins, which can divert vital blood away from the woundosome. This knowledge is essential for interventional radiologists to enhance treatment strategies and improve patient outcomes.