Abstract
Duplex ultrasound scanning (DUS) and magnetic resonance imaging are sometimes insufficient to meet our clinical needs due to specifics of given pathology and intrinsic technical limitations of these methods. This study aims to assess the need for multispiral computed tomography–venography (CT-venography) and to evaluate its diagnostic capabilities for various disorders in primary ambulatory patients in phlebology practice.Material and Methods. From January, 2017 to December,2019, a total of 10,112 patients sought initial consultation of a phlebologist. Upon examination, the physician assigned patients to one of the proposed categories using dedicated software. Analysis of these categories demonstrated the following pattern of morbidity: 2,167 patients (21.4%) had chronic venous disorders of class С0S-1 (CEAP classification); 4,460 patients (44.1%) had varicose veins of class C2-3 (CEAP classification); 351 patients (3.5%) had varicose veins of class C4-6; 570 patients (5.6%) had other diseases including post-thrombotic syndrome, acute thrombosis, thrombophlebitis, and venous malformations; and 2,564 patients (25.4%) were suffering from non-venous disorders. DUS was performed in all cases.Results. The study demonstrated that 260 patients required CT-venography constituting 2.6% of the total number of patients who came to the clinic in the indicated period. The direct venography with contrast medium injection through the peripheral veins was used in 156 cases (60%). Patients did not have any significant complications, such as acute kidney injury or worsening of chronic renal failure, severe allergic reactions to the contrast agent, or problems with the puncture site of peripheral veins.Conclusions: 1) CT-venography allowed to achieve the accurate three-dimensional imaging of the venous system, providing, in some cases, the necessary information for finding solutions on optimal management. 2) The need for CT-venography may occur in 2.6% of patients in ambulatory phlebology practice. 3) CT-venography is useful for diagnosing angiodysplasias, postthrombotic and non-thrombotic lesions, complicated varicose veins, especially in recurrence, and in some cases of acute deep vein thrombosis. 4) DUS is mandatory for hemodynamic assessment in all patients before CT-venography.
Highlights
Сегодня для анализа состояния глубокой венозной системы в основном применяется непрямая СКТ-венография путем инъекции контрастного препарата через кубитальную вену [7]
2) The need for CT-venography may occur in 2.6% of patients in ambulatory phlebology practice
3) CT-venography is useful for diagnosing angiodysplasias, postthrombotic and non-thrombotic lesions, complicated varicose veins, especially in recurrence, and in some cases of acute deep vein thrombosis
Summary
За период с января 2017 по декабрь 2019 г. в клинику амбулаторной флебологии за первичной консультацией обратились 10112 пациентов. При анализе указанных категорий спектр заболеваний был следующим: хронические заболевания вен нижних конечностей С0S-1по СЕАР – 2167 (21,4%) пациентов; варикозное расширение вен нижних конечностей С2-3 по СЕАР – 4460 (44,1%), С4-6 – 351 (3,5%); другая патология вен (посттромбофлебитический синдром, острые тромбозы, тромбофлебит, венозные мальформации) – 570 (5,6%); невенозная патология – 2564 (25,4%) пациента. При непрямой методике контрастный препарат вводили стандартно через кубитальную вену, скорость введения – 3,5 мл/с, объем – 1 мл/кг, начало сканирования – через 80 с. При прямой СКТ-венографии препарат в большинстве случаев вводили через пункцию подкожной вены. У тех пациентов, у кого периферическая пункция была затруднена по причине отека или отсутствия подходящих вен, пунктировали доступные вены выше или переходили на непрямую методику. Протокол прямой венографии представлен в таблице 1. Протокол прямой мультиспиральной компьютерной томографии-венографии Table 1.
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