Further anatomic characterization before therapy can ensure appropriate and effective treatment [10-13]. Understanding the anatomy could aid in the appropriate selection of treatment and reduce recurrence and complication rates. CTV Abdomen and Pelvis CTV of the abdomen and pelvis has been suggested in the literature in cases with signs of iliac or inferior vena cava (IVC) involvement [9]. Further anatomic characterization before therapy can ensure appropriate and effective treatment, thus reducing the frequency for reintervention [10-13]. Understanding the anatomy could aid in the selection of an appropriate treatment modality and reduce recurrence and complication rates. US Intravascular Iliac Veins IVUS has been cited as the most sensitive and specific imaging modality for detecting deep vein obstructive disease. Compared to multiplanar venography, IVUS has been found to be more sensitive for detecting significant stenosis. One study found that, in 26.3% of patients, significant lesions were detected with IVUS not initially seen with 3- view venography [42]. Up to 10% of significant stenotic lesions, however, could not be seen via IVUS and required trial balloon angioplasty to unmask stenosis [8]. IVUS has also shown utility at predicting when stenting for iliofemoral vein stenosis will result in symptomatic improvement. One study involving CEAP C4 to C6 study population has shown significant improvement symptomatology in stenting >50% iliofemoral vein stenosis (50% area reduction chosen by authors) [41]. MRV Lower Extremity MRV of the lower extremity 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]. Furthermore, understanding unique patient anatomy [10] could aid in the selection of the appropriate treatment modality and reduce recurrence and complication rates.
Lower Extremity Chronic Venous Disease. Further anatomic characterization before therapy can ensure appropriate and effective treatment [10-13]. Understanding the anatomy could aid in the appropriate selection of treatment and reduce recurrence and complication rates. CTV Abdomen and Pelvis CTV of the abdomen and pelvis has been suggested in the literature in cases with signs of iliac or inferior vena cava (IVC) involvement [9]. Further anatomic characterization before therapy can ensure appropriate and effective treatment, thus reducing the frequency for reintervention [10-13]. Understanding the anatomy could aid in the selection of an appropriate treatment modality and reduce recurrence and complication rates. US Intravascular Iliac Veins IVUS has been cited as the most sensitive and specific imaging modality for detecting deep vein obstructive disease. Compared to multiplanar venography, IVUS has been found to be more sensitive for detecting significant stenosis. One study found that, in 26.3% of patients, significant lesions were detected with IVUS not initially seen with 3- view venography [42]. Up to 10% of significant stenotic lesions, however, could not be seen via IVUS and required trial balloon angioplasty to unmask stenosis [8]. IVUS has also shown utility at predicting when stenting for iliofemoral vein stenosis will result in symptomatic improvement. One study involving CEAP C4 to C6 study population has shown significant improvement symptomatology in stenting >50% iliofemoral vein stenosis (50% area reduction chosen by authors) [41]. MRV Lower Extremity MRV of the lower extremity 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]. Furthermore, understanding unique patient anatomy [10] could aid in the selection of the appropriate treatment modality and reduce recurrence and complication rates.