However, there are rare cases in which US imaging is limited, such as obesity. In these cases, where characterization of lower extremity veins is suboptimal, CTV can be used adjunctively [9]. CTV Pelvis There is no relevant literature regarding the use of CTV of the pelvis in the evaluation of bilateral GSV insufficiency with visible varicose veins. However, a comprehensive understanding of the anatomy could aid in the appropriate selection of treatment, planning interventions, and decreasing complication rates. US Intravascular Iliac Veins There is no relevant literature regarding the use of iliac vein IVUS in the evaluation of bilateral GSV insufficiency with visible varicose veins. MRV Lower Extremity MR venography (MRV) of the lower extremity has not been cited as a first-line examination. However, given the high rate of recurrence 2 years postintervention (15%-35%), it has been suggested that further anatomic characterization before therapy may be useful and could result in selecting more effective treatment [10-13]. In rare cases in which US imaging is limited, characterization of lower extremity veins is suboptimal, or the goal is to avoid iodinated contrast, MRV can be used adjunctively [9]. MRV Pelvis There is no relevant literature regarding the use of MRV of the pelvis in the evaluation of asymptomatic bilateral GSV insufficiency with visible varicose veins. However, a comprehensive understanding of the anatomy could aid in the appropriate selection of treatment, planning interventions, and decreasing complication rates. 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 evaluation should include condition of the deep venous system, GSV, small saphenous vein (SSV), and accessory saphenous veins.
Lower Extremity Chronic Venous Disease. However, there are rare cases in which US imaging is limited, such as obesity. In these cases, where characterization of lower extremity veins is suboptimal, CTV can be used adjunctively [9]. CTV Pelvis There is no relevant literature regarding the use of CTV of the pelvis in the evaluation of bilateral GSV insufficiency with visible varicose veins. However, a comprehensive understanding of the anatomy could aid in the appropriate selection of treatment, planning interventions, and decreasing complication rates. US Intravascular Iliac Veins There is no relevant literature regarding the use of iliac vein IVUS in the evaluation of bilateral GSV insufficiency with visible varicose veins. MRV Lower Extremity MR venography (MRV) of the lower extremity has not been cited as a first-line examination. However, given the high rate of recurrence 2 years postintervention (15%-35%), it has been suggested that further anatomic characterization before therapy may be useful and could result in selecting more effective treatment [10-13]. In rare cases in which US imaging is limited, characterization of lower extremity veins is suboptimal, or the goal is to avoid iodinated contrast, MRV can be used adjunctively [9]. MRV Pelvis There is no relevant literature regarding the use of MRV of the pelvis in the evaluation of asymptomatic bilateral GSV insufficiency with visible varicose veins. However, a comprehensive understanding of the anatomy could aid in the appropriate selection of treatment, planning interventions, and decreasing complication rates. 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 evaluation should include condition of the deep venous system, GSV, small saphenous vein (SSV), and accessory saphenous veins.