Three-dimensional Computed Tomography Venography Research Articles

Association between the saphenous vein diameter and venous reflux on computed tomography venography in patients with varicose veins.

Three-dimensional computed tomography venography is a useful tool to identify increased saphenous vein diameter and provides a complementary road map for surgery in patients with varicose veins. In this study, we investigated the correlation between saphenous vein diameter on computed tomography venography and venous reflux detected on duplex ultraonography. We enrolled 152 patients (213 extremities) who underwent endovenous laser ablation therapy, following high ligation of the saphenofemoral junction between January 2014 and December 2019. All patients underwent preoperative computed tomography venography evaluation. The saphenous vein diameter was measured on computed tomography venography, and venous reflux was evaluated in the operating room using Doppler ultrasonography. Among the 152 patients included in the study, 61 showed varicose veins affecting the bilateral extremities. Among the 213 extremities investigated, 165 (77.5%) and 48 (22.5%) extremities showed varicosities involving the greater and lesser saphenous veins, respectively. Among all extremities, venous reflux was detected in 172 (80.8%). The mean diameter of the greater saphenous vein measured 5 cm distal to the saphenofemoral junction was 8.07±1.82 mm in patients with reflux and 5.11±1.20 mm in patients without reflux (p < .05). The small saphenous vein diameter measured 5 cm distal to the saphenopopliteal junction was 7.65±1.74 mm in patients with reflux and 5.04±1.80 mm in patients without reflux (p < .05). Based on the receiver operating characteristic curve, the greater saphenous vein threshold diameter of 5.880 mm measured 5 cm distal to the saphenofemoral junction was the optimal cut-off value to predict reflux (sensitivity 91.4%, specificity 81.8%). The lesser saphenous vein diameter of 5.285 mm measured 5 cm distal to the saphenopopliteal junction was the optimal cut-off value to predict reflux (sensitivity 94.9%, specificity 75.0%). Vein diameter cannot be used as an absolute reference for venous reflux; however, it may have predictive value in patients with varicose veins. Computed tomography venography based measurements of vein diameter may serve as a useful diagnostic tool to predict venous reflux and recommend treatment.

Three-dimensional computed tomography venography reconstruction facilitates identification of atypical radiologic features of May-Thurner syndrome

ObjectiveMay-Thurner syndrome (MTS) is typically characterized by compression of the left common iliac vein by the overlying right common iliac artery. The present study evaluated the occurrence of atypical imaging features of MTS using three-dimensional computed tomography venography reconstruction (3D-CTV) and analyzed their correlation with clinical features. MethodsWe analyzed the data from 268 patients with left lower extremity chronic venous disease (CVD) using 3D-CTV at a single institution from January to June 2019. An area stenosis percentage >50% was defined as significant venous compression. Of the 268 patients, 92 had at least one significant iliac and/or vena cava compression confirmed by 3D-CTV. Of the 92 patients, 89 underwent digital subtraction venography via the left common femoral vein, and the outcomes were compared with their 3D-CTV findings. Different types of venous compression were evaluated using 3D-CTV. The relationship among compression type, sex, age, and CVD symptoms was evaluated. ResultsA total of 106 venous compression sites were found in 92 patients. Atypical compression included inferior vena cava (IVC) compression and partial IVC compression (8.5% and 55.7%, respectively). Multiple compression sites were present in 13 patients (14.1%). The compression sites correlated significantly with clinical symptoms (P = .017) and were related to sex (P = .001). The number of patients with IVC and partial IVC compression but false-negative venography findings was four (33.3%) and six (50%), respectively. Conclusions3D-CTV facilitates the detection of atypical venous compression in patients with MTS with notable chronic symptoms. Patients with multiple compression sites had more severe clinical symptoms and greater false-negative rates with venography. IVC compression was more likely to occur in female patients with MTS.

Retrosigmoid Intradural Suprameatal Approach for Petroclival Meningioma

Background Anterior transpetrosal approach and the combined transpetrosal approach are the major surgical approaches for petroclival meningiomas. However, anterior petrosectomy is not preferable in cases with postoperative venous drainage disorder of the sylvian vein due to anatomical variations. Here we present a case of the successful removal of petroclival meningioma by the retrosigmoid intradural suprameatal approach (RISA). Case Presentation The patient was a 59-year-old woman with incidentally detected right petroclival meningioma. Although she had no neurological deficit, the tumor manifested with gradual growth on annual magnetic resonance imaging (MRI) during an 8-year follow-up. Three-dimensional computed tomography venography (3D–CTV) revealed sphenobasal type of the sylvian vein throughout the lateral side of the foramen ovale. Because the suprameatal tubercle was an obstacle to observe the Meckel's cave, RISA was selected for complete tumor excision. RISA could provide an excellent operative field around the Meckel's cave to confirm the remnant tumor. Postoperative MRI showed no evidence of the tumor, and the patient was discharged without any neurological deficit. Conclusion RISA can provide a favorable operative field for petroclival meningioma, particularly for cases with high risk of postoperative complications related to the sylvian vein. The link to the video can be found at: https://youtu.be/cfci_zk0StU .

LEV 9. Causes of Recurrent Varicose Vein After Endovenous Laser Ablation Therapy Confirmed by Three-Dimensional Computed Tomography Venography and Duplex Ultrasound

The objective of this study was to determine the cause and anatomic patterns of recurrent varices after endovenous laser ablation (EVLA). Patients who were treated for recurrent varicose vein after EVLA between January 2010 and December 2017 were enrolled. Pathophysiologic patterns of recurrence were assessed using three-dimensional computed tomography venography and later confirmed by surgery. Among 1694 patients who were treated for varicose vein, symptomatic recurrence of varicose vein after EVLA was observed in 12 patients (0.7%). Median period to recurrence was 4.3 (interquartile range, 2.4-10.6) years. Especially in four patients (33%), the recurrence was observed >10 years after the EVLA. The main anatomic source of recurrence was recurrent or remaining reflux at the saphenofemoral junction (SFJ; n = 6) or saphenopopliteal junction (SPJ; n = 4); in three of these cases, there was coexisting reflux from pelvic veins or perforators. Sources of the other two cases were perforator and untreated saphenous vein. The pathophysiologic mechanism underlying recurrent or remaining reflux at the SFJ or SPJ was either recanalization of treated saphenous vein (n = 6) or incompetent branches at the junction (n = 4). Recurrent varicose vein after EVLA was mainly caused by the recanalized saphenous vein or incompetent tributaries of the SFJ or SPJ. Three-dimensional computed tomography venography along with duplex ultrasound was useful in assessing the extent and the pathophysiologic mechanism of recurrent varicose vein.

Anatomic variations of lower extremity venous system in varicose vein patients: demonstration by three-dimensional CT venography.

Background Understanding the anatomy of the lower extremity veins is essential for successful varicose vein treatment. Computed tomography (CT) venography may be used to obtain a comprehensive overview and detailed information regarding this. Purpose To describe anatomic variations of the lower extremity venous system in patients with varicose veins, using three-dimensional (3D) CT venography. Material and Methods A total of 810 limbs in 405 patients with suspected varicose veins were prospectively referred to undertake CT venography and included in our study population retrospectively. The CT venography images were evaluated by consensus of two cardiovascular radiologists. Anatomical variations of the lower extremity venous system and their incidence were analyzed. Specifically, the number of tributaries at saphenofemoral junction, relative location of the great saphenous vein (GSV) with respect to the common femoral artery bifurcation, pattern of saphenopopliteal junction, and end of thigh extension from the small saphenous vein (SSV) were assessed. Results The most frequent number of tributaries joining the GSV was four (44.4%, 360/810). Only 0.7% (6/810) of the limbs demonstrated unusual location of the GSV between the bifurcated superficial and deep femoral arteries. The most common pattern of veins at the saphenopopliteal junction was a larger caliber of saphenopopliteal junction than thigh extension from SSV (43.8%, 355/810), end of which joining the femoral vein directly (41.0%, 288/703). Conclusion CT venography with 3D reconstruction can be used to understand the anatomy of lower extremity veins and how their variations contribute to varicose veins.

PC180. Iliac-femoral Post-Thrombotic Syndrome: Three-Dimensional CT Venography for Preintervention Evaluation and Midterm Stent Patency Follow-up

The study aimed to evaluate the imaging quality of three-dimensional computed tomography venography (3D-CTV) for iliac-femoral post-thrombotic syndrome (IFPTS) and midterm patency after stent angioplasty. A retrospective analysis of postthrombotic patients with iliac-femoral vein obstruction was conducted in a single institution from January 2013 to December 2014. 3D-CTV and digital subtraction angiography (DSA) were performed in 79 suspected IFPTS cases with Villalta score ≥10. The potential role of 3D-CTV in morphologic diagnosis was evaluated compared with DSA. Cumulative primary and secondary patency rates were followed up after stent angioplasty with 3D-CTV. 3D-CTV represents a sensitivity of 92.3% and a specificity of 71.4% for IFPTS morphologic diagnosis compared with DSA. The overall quality of 3D volume-rendered images (Fig 1) in the visualization of iliac-femoral vein was excellent in 82.2% of patients, fair in 12.7%, and poor in 5.1%. Percutaneous iliofemoral venous stenting (Fig 2) was successful in 63 of 65 patients (96.9%). Follow-up was a median of 21 months (range, 12-36 months). Cumulative primary and secondary stent patency rates at 2 years were 75.6% and 94.6%, respectively. Most of the stent restenosis/occlusion occurred at the 1 month follow- up after stent angioplasty (11 of 15 [73.3%]). 3D-CTV demonstrated satisfactory sensitivity and image quality for evaluating IFPTS and venous patency after stent angioplasty. Although most of stent restenosis or occlusion occurred in the early follow-up, initial luminal patency was well maintained during midterm follow-up.Fig 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Study of Changing Intracranial Venous Drainage Patterns in Petroclival Meningioma

To elucidate venous drainage patterns to avoid damage to the venous drainage route in the middle cranial fossa and superior petrosal sinus when employing the transpetrosal approach. Venous drainage patterns were assessed using three-dimensional computed tomography venography in 22 hemispheres of petroclival meningioma (PCM) cases from patients who underwent primary surgery and 40 hemispheres of control cases. Intracranial venous drainage patterns were compared between control cases and PCM cases. The proportion of hemispheres with complete and medial superior petrosal sinus drainage patterns was lower in PCM cases. With regard to the superficial middle cerebral vein drainage pattern, the proportion of hemispheres with the cavernous sinus capture type was lower and the proportion with the emissary type was higher in PCM cases. The proportion of hemispheres with multiple greater anastomoses of the superficial middle cerebral vein was higher in PCM cases without the emissary-type and cavernous sinus capture-type patterns. When the venous drainage route of the cavernous sinus capture type and/or emissary type was disturbed, in particular, greater anastomosis via the vein of Labbè and the vein of Trolard was needed to control venous drainage flow. In cases of venous drainage impairment secondary to PCM progression, the drainage route changed to the pterygoid plexus route through the emissary foramen and/or superior sagittal sinus and to the transverse sinus route through the greater anastomosis of the superficial middle cerebral vein. In the anterior transpetrosal approach, peeling off the dura propria of the trigeminal nerve of the foramen rotundum for petrous apex exposure may be associated with the potential risk of pterygoid plexus drainage route impairment.

Three-Dimensional Computed Tomography Venography as a Guide for Cranioplasty in Parietal Cephalocele

We present cranioplasty for a patient who underwent encephalocele surgery during infancy. Preoperative 3-dimensional computed tomography venography showed the skull defect and abnormal running of the superior sagittal sinus in simultaneous images. Using computed tomography venography images as a guide, we could safely harvest full-thickness calvarial bone from the contralateral side of the superior sagittal sinus.

Comment to: Pre-operative determination of anatomic variations of the small saphenous vein for varicose vein surgery by three-dimensional computed tomography venography, by Kim SY, Park EA, Shin YC, et al. Phlebology 2012;27:235-41.

Short saphenous vein (SSV) surgery is more challenging due to higher recurrence and complication rates than great saphenous vein (GSV) surgery. The main reason for that is the presence of many anatomic variations in SSV anatomy and the close proximity of the vein with adjacent nerves in the somewhat crowded popliteal fossa. Accurate anatomic knowledge about the varicose veins (VV) and neural topography is necessary to prevent nerve damage during surgery. Duplex ultrasound (DUS) imaging is the gold standard investigation for VV, but has limitations such as operator-dependent variable results, a time-consuming procedure, possible omission of perforators in unusual locations and a difficulty in the evaluation of pelvic vessels. Three-dimensional computed tomography venography (3D-CTV) cannot replace DUS, but can provide additional powerful 3D images. The exact anatomy of the individual patient can be evaluated before surgery, so that the surgery can be performed with full knowledge of the patient specific anatomy and hemodynamic. This may contribute to minimizing complications and recurrence after VV surgery with SSV reflux. From January 2005 until December 2007 a total of 120 limbs in 103 patients with SSV insufficiency confirmed by duplex underwent conventional operations of high ligation, segmental stripping and varicosectomy....

Preoperative determination of anatomic variations of the small saphenous vein for varicose vein surgery by three-dimensional computed tomography venography

To define the anatomical variations of small saphenous vein (SSV) for varicose vein (VV) surgery by three-dimensional computed tomography venography (3D-CTV) and to analyse the impact of this preoperative evaluation on surgical outcomes. A total of 120 consecutive limbs with SSV insufficiency having undergone VV surgery from January 2005 until December 2007 were enrolled. The medical records and images were analysed retrospectively. The relationship between SSV and gastrocnemial vein (GNV) were categorized into two: (a) SSV and GNV drained to popliteal vein (PV) separately (100 limbs, 87%) and (b) SSV and GNV made common channel which drained to PV (15 limbs, 13%). Saphenopopliteal junction morphology was normal (75 limbs), severe tortuosity near PV (19 limbs), ampullary ectasia (4 limbs) and duplicated drainage to PV (2 limbs). No recurrence of VV was noted. CTV can provide thorough preoperative anatomic information of the SSV variations and reduce the recurrence of VV.

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

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. 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. 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. 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.

Role of three-dimensional computed tomography venography as a powerful navigator for varicose vein surgery

Computed tomography venography (CTV) with three-dimensional reconstruction can provide complementary road maps for varicose vein (VV) surgery. The purpose of this study is to verify the role of CTV in the treatment of VV in terms of advantages and complications. Ninety-four consecutive patients with VV underwent conventional high ligation, stripping, and varicosectomy by a single vascular surgeon in 2007. All patients were evaluated with duplex ultrasound and CTV. Patients with renal dysfunction, allergy to radiocontrast, telangiectasia only, or treated by endovenous laser therapy (EVLT) were excluded from the study. Computed tomography (CT) examination was performed with a 16-Multidetector CT scanner (Siemens, Erlangen, Germany) and 3D images were reconstructed by personal computer-based software (Rapidia, Infinitt, Seoul, Korea). Medical records and the CT images were reviewed retrospectively. VV surgeries were done in 127 limbs of 94 patients (both in 33, right in 29, and left in 32). There were 56 females and 38 males with the mean age of 57 years (range, 28-79 years). The CEAP classification was C(2-3) EpAsPr. Perforators larger than 1 mm near the varicose veins were detected and marked on the CT volume-rendering images. The average numbers of perforators marked by CTV were 12.07 +/- 4.27 in each limb. The perforators were evaluated by duplex for the presence of reflux (>or=0.5 sec). Mean number of perforators with reflux in each limb was 1.41 +/- 1.67, which were ligated during the surgery. Incidental detections of other disease were done in six patients, including uterine myomas, an ovarian cyst, a gallstone, a scrotoal varicocele, and a pes anserine bursitis. Operation was performed with the CTV images on screen. CTV was helpful in designing the operation in most patients. Three-D CTV images of saphenopopliteal junction especially provided thorough understanding of the complex variable anatomy of the lesion. There were no CT-related complications, such as renal dysfunction or allergic reaction. CT venography can provide excellent road map for VV surgery without significant complications. It cannot replace duplex ultrasound, but can provide powerful 3D images for designing operation as well as education and research.

PP82. Three-Dimensional Computed Tomography Venography; a Powerful Navigator for Varicose Vein Surgery

CT venography(CTV) with 3-dimensional reconstruction can provide complementary road maps for varicose vein (VV) surgery. The purpose of this study is to verify the role of CTV in the treatment of VV in terms of advantages and complication. Ninety four consecutive patients with VVs were performed conventional high ligation, stripping and varicosectomy by a single vascular surgeon in 2007. All patients were evaluated with duplex ultrasound and CT venography. Patients with renal dysfunction, allergy to radiocontrast, telangiectasia only or treated by EVLT were excluded from the study. CT examination was performed with a 16-MDCT scanner(Siemens) and 3D images were reconstructed by a PC-based software (Rapidia, Infinitt). Medical records and the CT exam were reviewed retrospectively. VV surgeries were done in 162 limbs of 94 patients (both in 68, right in 18, and left in 8). There were 56 females and 38 males with the mean age of 57 years (2879). The CEAP classification was C2-3EpAsPr in all patients. Perforators larger than 2mm near the varicose veins were detected and marked on the CT volume-rendering images. The average numbers of perforators marked by CTV were 13.4±4.22 in each limb. The perforators were evaluated by duplex for the presence of reflux (≥0.5 sec). Mean number of perforators with reflux in one limb was 1.3 ±1.35, which were ligated during the surgery. Incidental detections of other disease were done in 3 patients, including uterine myomas and ovarian cyst. Operation was performed with the CTV images on screen. CTV was helpful in designing the operation in most patients. 3D CTV images of saphenopopliteal junction especially provided thorough understanding of the complex variable anatomy of the lesion. There were no CT-related complications, such as renal dysfunction or allergic reaction. CT venography can provide excellent road map for VV surgery without significant complications. It cannot replace duplex USG, but can provide powerful 3D views for designing operation as well as education and research.