Secondary chronic venous disease describes a phenomenon in which primary thrombotic events cause a post-thrombotic syndrome. In addition to an occlusive IVC or iliac vein lesion, these cases also show signs of delayed or incomplete recanalization of the pelvic and lower extremity deep veins with extensive intraluminal changes. In both of the above types, primary focus should be on anatomy to accurately identify stenosis and occlusion related to outflow obstruction [9]. CTV of the abdomen and pelvis has been suggested in the literature in cases in which there are signs of iliac vein or IVC involvement, and in cases with fast recurrence of varicose veins after adequate treatment, CTV clearly identifies stenosis, occlusion, venous atresia, collaterals, and edema [9]. Further highlighting the importance of CTV before intervention is the high rate of recurrence 2 years postintervention (15%-35%). Further anatomic characterization before therapy can ensure appropriate and effective treatment [10-13]. Understanding anatomy could aid in the selection of appropriate treatment modality and reduce recurrence and complication rates. In this study, retrospective evaluation of a prospectively acquired database, out of 810 studied limbs, there were numerous anatomic variations, including 1 anatomic variant that had not been described in the literature [11]. Characterization of these potential variants is important for treatment planning purposes. US Intravascular Iliac Veins IVUS has been cited as the most sensitive and specific modality for deep vein obstructive disease. Up to 10% of significant stenotic lesions, however, could not be seen via IVUS and required trial balloon angioplasty to unmask stenosis [8]. Catheter venography with IVUS should be performed in those with an indication for venous intervention such as iliac vein stenting [6]. MRV Lower Extremity MRV of the lower extremity has not been cited as a first-line examination.
Lower Extremity Chronic Venous Disease. Secondary chronic venous disease describes a phenomenon in which primary thrombotic events cause a post-thrombotic syndrome. In addition to an occlusive IVC or iliac vein lesion, these cases also show signs of delayed or incomplete recanalization of the pelvic and lower extremity deep veins with extensive intraluminal changes. In both of the above types, primary focus should be on anatomy to accurately identify stenosis and occlusion related to outflow obstruction [9]. CTV of the abdomen and pelvis has been suggested in the literature in cases in which there are signs of iliac vein or IVC involvement, and in cases with fast recurrence of varicose veins after adequate treatment, CTV clearly identifies stenosis, occlusion, venous atresia, collaterals, and edema [9]. Further highlighting the importance of CTV before intervention is the high rate of recurrence 2 years postintervention (15%-35%). Further anatomic characterization before therapy can ensure appropriate and effective treatment [10-13]. Understanding anatomy could aid in the selection of appropriate treatment modality and reduce recurrence and complication rates. In this study, retrospective evaluation of a prospectively acquired database, out of 810 studied limbs, there were numerous anatomic variations, including 1 anatomic variant that had not been described in the literature [11]. Characterization of these potential variants is important for treatment planning purposes. US Intravascular Iliac Veins IVUS has been cited as the most sensitive and specific modality for deep vein obstructive disease. Up to 10% of significant stenotic lesions, however, could not be seen via IVUS and required trial balloon angioplasty to unmask stenosis [8]. Catheter venography with IVUS should be performed in those with an indication for venous intervention such as iliac vein stenting [6]. MRV Lower Extremity MRV of the lower extremity has not been cited as a first-line examination.