{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T03:55:32Z","timestamp":1790567732224,"version":"4.1.0"},"reference-count":16,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Vasc Endovascular Surg"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The role of incompetent perforating veins (IPVs) in varicose veins is controversial. There are different views on the mechanism of \u201cincompetence\u201d and, hence, the importance of IPVs. Those following CHIVA and \u201chaemodynamic surgery\u201d principles suggest higher velocities in the deep veins cause blood to flow inwards due to the Venturi effect. The senior author of this case has previously proposed that increased pressure by muscle activity forces blood out of any IPV, a phenomenon called \u201cactive\u201d reflux. This case report appears to show active reflux in an isolated IPV using infrared thermography.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 34-year-old lady presented with a tender lower leg varicose vein due to an isolated IPV. She was placed supine and still for 10 minutes, then performed 10 plantar- and dorsi-flexions. Next, she stood up and stood still for 10 minutes. Her leg was monitored throughout using an infra-red camera (IFC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Immediately on lying, the IFC showed the vein, indicating blood flowing out of the IPV from the warm deep compartment into the colder superficial compartment (passive\/diastolic or gravitational reflux). Over 10 minutes, the signal reduced significantly, suggesting no more blood was being pumped out through the IPV. During 10 plantar- and dorsi-flexions, the signal returned strongly, indicating blood being pumped out of the IPV once again. On standing, the signal was strong initially, but after 10 min of standing still, the signal had faded, indicating a lack of passive (gravitational) reflux in the IPV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case suggests that reflux through this IPV is due to muscle activity and not by passive reflux due to gravity. This could explain why IPVs can cause fasciocutaneous damage and\/or varicose veins in the lower limb. If correct, failure to identify and treat IPVs during varicose vein surgery would mean that the procedure would be inadequate.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15385744261491459","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T23:42:44Z","timestamp":1790293364000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Active (Systolic) Reflux Demonstrated in a Below-Knee Isolated Incompetent Perforating Vein Associated With a Symptomatic Varicose Vein Using Infrared Thermography, Illustrated by a Case Report"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6727-6245","authenticated-orcid":false,"given":"Mark S.","family":"Whiteley","sequence":"first","affiliation":[{"name":"Research Department, The Whiteley Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3521-5480","authenticated-orcid":false,"given":"Oscar F.","family":"Leveque","sequence":"additional","affiliation":[{"name":"Research Department, The Whiteley Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2014.06.044"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1258\/phleb.2009.009071"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.23736\/S0392-9590.21.04650-2"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2018.01.013"},{"issue":"1","key":"e_1_3_5_6_2","first-page":"87","article-title":"Evaluation of the perforating veins of the lower extremity using high resolution duplex imaging","volume":"32","author":"Hanrahan LM","year":"1991","unstructured":"Hanrahan LM, Araki CT, Fisher JB, et al. Evaluation of the perforating veins of the lower extremity using high resolution duplex imaging. J Cardiovasc Surg. 1991;32(1):87-97. PMID: 2010459.","journal-title":"J Cardiovasc Surg"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/02683555231213146"},{"issue":"1","key":"e_1_3_5_8_2","first-page":"8","article-title":"CHIVA: hemodynamic concept, strategy and results","volume":"35","author":"Franceschi C","year":"2016","unstructured":"Franceschi C, Cappelli M, Ermini S, et al. CHIVA: hemodynamic concept, strategy and results. Int Angiol. 2016;35(1):8-30. Epub 2015 Jun 5. PMID: 26044838.","journal-title":"Int Angiol"},{"key":"e_1_3_5_9_2","volume-title":"Principles of Venous Hemodynamic","author":"Franceschi C","year":"2009","unstructured":"Franceschi C, Zamboni P. Principles of Venous Hemodynamic. New York: Nova science Publishers; 2009."},{"key":"e_1_3_5_10_2","volume-title":"Understanding Venous reflux-the Cause of Varicose Veins and Venous Leg Ulcers","author":"Whiteley M","year":"2011","unstructured":"Whiteley M. Understanding Venous reflux-the Cause of Varicose Veins and Venous Leg Ulcers. 2nd ed. Guildford, UK: Whiteley Publishing; 2011.","edition":"2"},{"key":"e_1_3_5_11_2","unstructured":"Lurie F Gates K. Impact of thermographic imaging on clinical decision making for patients with superficial venous disease (Presentation). European venous forum AGM Athens 27-29 June 2024. https:\/\/europeanvenousforum.org\/index.php\/24th-evf-scientific-programme\/. Accessed 21 August 2024."},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1067\/mva.2001.119239"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.5945"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1258\/phleb.2008.008005"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1053\/ejvs.2001.1347"},{"key":"e_1_3_5_16_2","unstructured":"Franceschi C. Venous insufficiency of pelvis and lower limbs: hemodynamic rationale of pathophysiology diagnosis and treatment. e-Book .https:\/\/zenodo.org\/records\/6740125. accessed 17 September 2026."},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","unstructured":"Whiteley MS Leveque OF Active (systolic) reflux demonstrated in a below-knee isolated incompetent perforating vein associated with a symptomatic varicose vein using infrared thermography illustrated by a case report (2025). doi:10.31219\/osf.io\/4evj2_v1","DOI":"10.31219\/osf.io\/4evj2_v1"}],"container-title":["Vascular and Endovascular Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15385744261491459","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15385744261491459","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15385744261491459","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T03:16:31Z","timestamp":1790565391000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15385744261491459"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,24]]},"references-count":16,"alternative-id":["10.1177\/15385744261491459"],"URL":"https:\/\/doi.org\/10.1177\/15385744261491459","relation":{},"ISSN":["1538-5744","1938-9116"],"issn-type":[{"value":"1538-5744","type":"print"},{"value":"1938-9116","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,24]]},"article-number":"15385744261491459"}}