Do Veins Have Valves

Do Veins Have Valves?

Presence of Valves in Veins

Valves in Small Veins and Venules

Contrary to the common belief that valves are absent in veins smaller than two millimeters in diameter, research has shown that microscopic venous valves (MVVs) do exist in small veins and venules. These valves play a crucial role in preventing blood reflux and ensuring unidirectional blood flow from postcapillary venules back into the capillary bed. This is supported by clinical findings where skin grafts rich in MVVs have led to long-lasting healing of leg ulcers caused by chronic venous disease (CVD).

Valves in the Dermal Microcirculation

Valve-containing collecting veins, ranging from 70 to 120 microns in diameter, have been identified at the dermal-subcutaneous junction. These valves are typically bicuspid and are found at points where smaller venules enter larger veins, as well as within the lumens of larger veins. Their presence is physiologically significant, as they help manage the pulsatile blood flow observed in human nail-fold capillaries.

Micro-Venous Valves in the Lower Limb

In the human lower limb, venous valves are abundant even in small superficial veins. A study using vascular casts and scanning electron microscopy identified 2,376 valves in subcutaneous tissue, with the majority located in veins less than 300 microns in diameter. This demonstrates that small superficial veins contain numerous venous valves, with many present in venous channels as small as 18 microns in diameter.

Valves in Larger Veins

Deep Vein Valves

Deep veins, such as the femoral and popliteal veins, contain multiple valves. Studies have shown that the femoral vein can have between one and six valves, while the popliteal vein can have between zero and four valves. These valves are consistently located at specific points, such as within 5 cm of the inguinal ligament in the common femoral vein and near the adductor hiatus in the popliteal vein. This anatomical consistency is crucial for understanding and treating deep venous diseases.

Valves Near the Saphenofemoral Junction

The great saphenous vein (GSV) near the saphenofemoral junction (SFJ) also contains valves, although their presence can vary. On average, there are about two valves per GSV, but terminal and preterminal valves are not always present. This variability can influence the occurrence of reflux from the common femoral vein into the GSV and its tributaries, which is a factor in the development of varicose veins .

Molecular Mechanisms and Development

Role of Connexins in Valve Development

The development and maintenance of venous valves involve specific molecular mechanisms. Connexin proteins, such as Cx37, Cx43, and Cx47, are crucial for valve formation. In mice lacking Cx37, venous valves are entirely absent, indicating the importance of this protein in valve development. These connexins are expressed in a highly polarized manner in venous valves, suggesting a complex regulatory mechanism that ensures proper valve function .

Conclusion

In summary, veins do have valves, and these are present not only in large veins but also in small veins and venules. These valves are essential for maintaining unidirectional blood flow and preventing reflux, which is critical for overall venous health. Understanding the distribution, structure, and molecular mechanisms of venous valves can provide insights into the treatment and management of venous diseases.

Summary

Consensus Meter