Up to 10% of significant stenotic lesions, however, could not be seen via IVUS and required trial balloon angioplasty to unmask stenosis [8]. US Intravascular Renal Veins There is no relevant literature regarding the use of IVUS for renal veins in the evaluation of pelvic-derived lower extremity varicose veins in women, although it can accurately characterize the severity of a stenosis of a renal vein but compression over the adjacent aorta and superior mesenteric artery. MRV Abdomen and Pelvis MRV of the abdomen and pelvis can identify stenosis, occlusion, venous atresia, collaterals, and edema. In addition, MRV can show webs, trabeculations, and vein wall thickening [9]. MRV can also demonstrate the diameters of pelvic veins and ovarian veins to identify those that are varicose (>5 mm periuterine and periovarian veins and >6- 8 mm in diameter ovarian veins) [50]. Further highlighting the importance of MRV before intervention is a high Lower Extremity Chronic Venous Disease rate of recurrence 2 years postintervention (15%-35%). 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]. Duplex US evaluation should additionally include condition of the deep venous system, GSV, SSV, and accessory saphenous veins. Presence and location of clinically relevant perforating veins and extent of possible alternative refluxing superficial venous pathways should also be included in any duplex US evaluation [1].
Lower Extremity Chronic Venous Disease. Up to 10% of significant stenotic lesions, however, could not be seen via IVUS and required trial balloon angioplasty to unmask stenosis [8]. US Intravascular Renal Veins There is no relevant literature regarding the use of IVUS for renal veins in the evaluation of pelvic-derived lower extremity varicose veins in women, although it can accurately characterize the severity of a stenosis of a renal vein but compression over the adjacent aorta and superior mesenteric artery. MRV Abdomen and Pelvis MRV of the abdomen and pelvis can identify stenosis, occlusion, venous atresia, collaterals, and edema. In addition, MRV can show webs, trabeculations, and vein wall thickening [9]. MRV can also demonstrate the diameters of pelvic veins and ovarian veins to identify those that are varicose (>5 mm periuterine and periovarian veins and >6- 8 mm in diameter ovarian veins) [50]. Further highlighting the importance of MRV before intervention is a high Lower Extremity Chronic Venous Disease rate of recurrence 2 years postintervention (15%-35%). 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]. Duplex US evaluation should additionally include condition of the deep venous system, GSV, SSV, and accessory saphenous veins. Presence and location of clinically relevant perforating veins and extent of possible alternative refluxing superficial venous pathways should also be included in any duplex US evaluation [1].