Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011;4(3):229-34.
doi: 10.3400/avd.oa.11.00021. Epub 2011 Jul 29.

Three-dimensional CT Venography: A Diagnostic Modality for the Preoperative Assessment of Patients with Varicose Veins

Katsutoshi Sato  1 , Kazumasa Orihashi, Shinya Takahashi, Taiichi Takasaki, Tatsuya Kurosaki, Katsuhiko Imai, Minoru Ishifuro, Taijiro Sueda
Affiliations

Three-dimensional CT Venography: A Diagnostic Modality for the Preoperative Assessment of Patients with Varicose Veins

Katsutoshi Sato et al. Ann Vasc Dis. 2011.

Abstract

Objective: We preoperatively assessed varicose veins by means of computed tomography (CT) with contrast injection in the veins of the lower extremity (CT venography). This paper reports the procedures, results and implications of CT venography from the surgical aspect.

Methods: A total of 48 legs in 39 patients were examined. Contrast medium was diluted ten-fold and injected into the lower extremity veins, often using a dual route of injection. The images were reconstructed with the volume-rendering method.

Results: CT venography clearly visualized the veins with a small amount of contrast medium and facilitated the identification of anatomy that was not suitable for passing the stripper. In addition, CT venography helped identify unusual types of varicose veins or uncommon sites of inflow of small saphenous veins. Such information was helpful for avoiding unexpected vascular injury or for minimizing skin incision. Dual-route injection was beneficial to minimize the blind zones. Doppler ultrasound could be more focused on hemodynamic assessment and determination of incision sites.

Conclusions: CT Venography is feasible in all cases of varicose veins. When performed in conjunction with ultrasonography, it appears to facilitate the safe and efficient treatment of various types of varicose veins.

Keywords: computed tomography; varicose vein; venography.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Venography CT images: superficial 3D view (left) and deep 3D view (right). A: great saphenous vein type. * Axial views of the thigh are shown. In the superficial femoral vein, a partial filling defect mimicking deep vein thrombosis was noted. B: small saphenous vein type. Saphenous vein, deep veins and perforators in the entire extremity are clearly visualized. SFV: superficial femoral vein; GSV: great saphenous vein; SFJ: saphenofemoral junction; PV: popliteal vein; SSV: small saphenous vein; SPJ: saphenopopliteal junction
Fig. 2
Fig. 2
Unusual course of the saphenous vein visualized with CT venography. A: angulated course of the vein. B: venous aneurysm. C: large branch connected to the varicose vein. These can lead to unexpected vein injury during the stripping procedure.
Fig. 3
Fig. 3
Uncommon types of varicose veins. A: Vulval varicose vein (arrow) with normal saphenofemoral junction and slightly dilated saphenous trunk. B: Branched saphenous vein (arrow) causing regurgitation at the saphenofemoral junction, but without regurgitation in the saphenous trunk. C: Distal portion of great saphenous varicose vein due to incompetent perforator (arrow). D: Giacomini vein (arrow) with regurgitation of saphenopopliteal junction and dilated great saphenous vein. SFV: superficial femoral vein; GSV: great saphenous vein; SSV: small saphenous vein
Fig. 4
Fig. 4
Small saphenous vein connecting to the femoral vein. There is no connection to the popliteal vein (white arrow). A: Venous aneurysm of small saphenous vein with a large thrombus (black arrow). B: Division into several small veins. SFV: superficial femoral vein; PV: popliteal vein; SSV: small saphenous vein
See this image and copyright information in PMC

References

    1. Kurdal AT, Cerrahoglu M, Iskesen I.Subfascial endoscopic perforator surgery ameliorates the symotoms of chronic venous ulcer (C6) patients. Int Angiol 2010; 29: 70-4 - PubMed
    1. Nadarajah ST, Demos D, Andrew IDM.Endovenous laser ablation: dose standard above-knee great saphenous vein ablation provide optimum results in patients with both above- and below-knee reflux? A randomized controlled trial. J Vasc Surg 2008; 48: 173-8 - PubMed
    1. Koyano K, Sakaguchi S. Selective stripping operation based on Doppler ultrasonic findings for primary varicose veins of the lower extremities. Surgery 1988; 103: 615-9 - PubMed
    1. Kistner RL, Ferris EB, Randhawa G.A method of performing descending venography. J Vasc Surg 1986; 4: 464-8 - PubMed
    1. Jutley RS, Cadle I, Cross KS. Preoperative assessment of primary varicose veins: a Duplex study of venous incompetence. Eur J Vasc Endovasc Surg 2001; 21: 370-3 - PubMed

LinkOut - more resources