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The Calf Muscle Pump and Venous Blood Flow - Vein Treatment Center in Buffalo Niagara
Tuesday, August 13, 2013



Blood flow from the lower extremities is complex but efficient.  Three different types of vein systems interact efficiently to pump blood out of the legs.  The three systems are the superficial veins of the lower extremities, the deep vein and the perforator veins.  Perforator veins connect the superficial veins of the lower extremity to the deep veins through the fascia of the muscle.


Deficient interaction of the superficial and deep veins via perforator veins is necessary for blood flow out of the legs.  There are four muscle compartments in the legs and within these muscles are housed the deep veins of the lower extremities.  The superficial veins, the deep veins, and perforator veins have valves.  Proper valve function allows blood to get out of the deep veins into the superficial veins via perforator veins.  There are at least 80 perforator veins in each lower extremity.  The named perforator veins below the knee are the Cockett’s perforators and Boyd’s perforator veins below the knee as well as the gastrocnemius group of perforator veins.



There are at least four compartments of muscles in the leg below the knee which are invested in fascial layers.  In the upright position blood tends to pool in the lower extremities and efficient calf muscle function is necessary to pump blood out of the legs.  Upon contraction of the calf muscle pump, the pressure in the deep vein system exceeds 100 mmHg.  Once the calf muscle pumps blood out of the deep vein system the pressure drop allows blood to go efficiently from the superficial veins into the deep veins via the perforator veins as well as at the saphenofemoral and saphenopoliteal junctions.


Competent valves in the perforator veins prevent blood from pooling back from the deep veins into the superficial veins.  The distal pump, namely the calf muscles are activated by dorsal flexion of the ankle.  The calf muscles are stretched. This movement together with competent perforator vein valves as well as competent valves in the deep and superficial veins allows efficient blood flow out of the lower extremities.



It should be noted that the foot pump is independent of muscular movements.



During normal walking, the three systems of veins namely  the deep veins, superficial veins, and perforator veins are synchronized to provide serial and parallel pumps which aide in the egress of blood out of the legs.


Calf muscle physiology is complex and alternations in any one of these systems or loss of muscular bulk with aging (sarcopenia) results in alternation and inefficient blood blow out of the legs.



For more information about treatment for perforator venous reflux, superficial venous reflux, or deep venous reflux contact Hratch Karamanoukian, MD FACS at the Vein Treatment Center with offices in Williamsville, New York and Clarence, New York.  You can also contact Dr. Karamanoukian through or by calling 716-839-3638 to schedule an appointment for consultation and evaluation. and are partners with




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