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Cockett's Perforator Reflux - EVLT versus SEPS - Vein Treatment Center Buffalo Niagara
Wednesday, August 7, 2013



 The Cockett’s perforator veins are the most significant medial calf perforators.  They connect the posterior arch vein, also known as Leonardo’s vein through the paired posterior tibial veins in the leg.  As such, it has been shown that stripping of the great saphenous vein will not affect physiologic venous blood flow through these perforator veins.


There are three groups of Cockett’s perforator veins that have been identified by anatomic dissection.  The Cockett’s I group of perforators are located behind the medial malleolus.  The Cockett’s II group of perforator veins and the Cockett’s III group of perforator veins are located between 7 to 10 and 10 to 12.5 cm proximal to the medial malleolus of the ankle (inner ankle bone).


All of the perforator veins are found in Linton’s line which is 2 to 4 cm posterior to the medial edge of the tibial bone.


Today Cockett’s perforator veins are no longer treated or rarely treated with surgical ligation. The SEPS (subfascial endoscopic perforator surgery) is also rarely performed.  Instead,  perforator veins are obliterated successfully using endovenous laser therapy using the EVLT Never Touch system.


For more information about treating Cockett’s perforator veins, contact Hratch Karamanoukian, MD FACS at the Vein Treatment Center with offices in Williamsville, New York and Clarence, New York by calling 716-839-3638 or going to


In the Los Angeles area, contact Raffy Karamanoukian MD FACS at the Santa Monica Vein Center by calling 310-998-5535 or going to



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