In cases in which characterization of lower extremity veins is suboptimal, MRV can be used adjunctively [9]. MRV Abdomen and Pelvis MRV of the abdomen and pelvis has not been cited as a first-line examination. As with CTV, MRV identifies stenosis, occlusion, venous atresia, collaterals, and edema. In addition, MRV can show webs, trabeculations, and vein wall thickening [9]. Further anatomic characterization before therapy can ensure appropriate and effective treatment [10-13]. Characterization of these potential variants is important for treatment planning purposes. US Duplex Doppler Lower Extremity It is widely agreed upon that duplex US should be the first assessment of the lower extremity venous system [1,9,14]. Duplex US is currently the most common imaging technique because it is noninvasive. Evaluation should include direction of blood flow, assessment for venous reflux, and venous obstruction [20]. Additionally, duplex US evaluation should include the condition of the deep venous system, GSV, SSV and its thigh extension (Giacomini Vein), and accessory saphenous veins. Presence and location of perforating veins near a VLU should also be included in any duplex US evaluation [1]. Lower Extremity Chronic Venous Disease If after treatment an ulcer recurs, repeat duplex US should assess for recanalization of treated GSV or reflux into the Giacomini vein, transmitting to the short saphenous vein [8]. Arterial vascular characterization may also prove useful because it has been noted that 16% of patients with VLU have concomitant arterial occlusive disease, which is frequently not recognized [19,43]. US Duplex Doppler IVC and Iliac Veins As in arterial vasculature, critical stenosis is defined by a sharp reduction in forward flow; in venous vasculature, critical stenosis is related to venous hypertension. In fact, the beneficial effects of venous stenting are related to peripheral venous decompression [44].
Lower Extremity Chronic Venous Disease. In cases in which characterization of lower extremity veins is suboptimal, MRV can be used adjunctively [9]. MRV Abdomen and Pelvis MRV of the abdomen and pelvis has not been cited as a first-line examination. As with CTV, MRV identifies stenosis, occlusion, venous atresia, collaterals, and edema. In addition, MRV can show webs, trabeculations, and vein wall thickening [9]. Further anatomic characterization before therapy can ensure appropriate and effective treatment [10-13]. Characterization of these potential variants is important for treatment planning purposes. US Duplex Doppler Lower Extremity It is widely agreed upon that duplex US should be the first assessment of the lower extremity venous system [1,9,14]. Duplex US is currently the most common imaging technique because it is noninvasive. Evaluation should include direction of blood flow, assessment for venous reflux, and venous obstruction [20]. Additionally, duplex US evaluation should include the condition of the deep venous system, GSV, SSV and its thigh extension (Giacomini Vein), and accessory saphenous veins. Presence and location of perforating veins near a VLU should also be included in any duplex US evaluation [1]. Lower Extremity Chronic Venous Disease If after treatment an ulcer recurs, repeat duplex US should assess for recanalization of treated GSV or reflux into the Giacomini vein, transmitting to the short saphenous vein [8]. Arterial vascular characterization may also prove useful because it has been noted that 16% of patients with VLU have concomitant arterial occlusive disease, which is frequently not recognized [19,43]. US Duplex Doppler IVC and Iliac Veins As in arterial vasculature, critical stenosis is defined by a sharp reduction in forward flow; in venous vasculature, critical stenosis is related to venous hypertension. In fact, the beneficial effects of venous stenting are related to peripheral venous decompression [44].