Role of three-dimensional computed tomography venography as a powerful navigator for varicose vein surgery

Objective To define the anatomical variations of small saphenous vein (SSV) for varicose vein (VV) surgery by three-dimensional computed tomography venography (3D-CTV) and to analyse the impact of this preoperative evaluation on surgical outcomes. Methods A total of 120 consecutive limbs with SSV insufficiency having undergone VV surgery from January 2005 until December 2007 were enrolled. The medical records and images were analysed retrospectively. Results The relationship between SSV and gastrocnemial vein (GNV) were categorized into two: (a) SSV and GNV drained to popliteal vein (PV) separately (100 limbs, 87%) and (b) SSV and GNV made common channel which drained to PV (15 limbs, 13%). Saphenopopliteal junction morphology was normal (75 limbs), severe tortuosity near PV (19 limbs), ampullary ectasia (4 limbs) and duplicated drainage to PV (2 limbs). No recurrence of VV was noted. Conclusions CTV can provide thorough preoperative anatomic information of the SSV variations and reduce the recurrence of VV.

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Recurrent varicose veins below the knee after varicose vein surgery

Phlebologie ◽

10.1055/s-0037-1622175 ◽

2007 ◽

Vol 36 (03) ◽

pp. 132-136

Author(s):

M. W. de Haan ◽

J. C. J. M. Veraart ◽

H. A. M. Neumann ◽

P. A. F. A. van Neer

Keyword(s):

Varicose Vein ◽

Varicose Veins ◽

Varicose Vein Surgery ◽

Proximal Point ◽

Perforating Veins ◽

Recurrent Varicose Veins ◽

Below The Knee ◽

Duplex Imaging ◽

Additional Value

SummaryThe objectives of this observational study were to investigate whether varicography has additional value to CFDI in clarifying the nature and source of recurrent varicose veins below the knee after varicose vein surgery and to investigate the possible role of incompetent perforating veins (IPV) in these recurrent varicose veins. Patients, material, methods: 24 limbs (21 patients) were included. All patients were assessed by a preoperative clinical examination and CFDI (colour flow duplex imaging). Re-evaluation (clinical and CFDI) was done two years after surgery and varicography was performed. Primary endpoint of the study was the varicographic pattern of these visible varicose veins. Secondary endpoint was the connection between these varicose veins and incompetent perforating veins. Results: In 18 limbs (75%) the varicose veins were part of a network, in six limbs (25%) the varicose vein appeared to be a solitary vein. In three limbs (12.5%) an incompetent sapheno-femoral junction was found on CFDI and on varicography in the same patients. In 10 limbs (41%) the varicose veins showed a connection with the persistent below knee GSV on varicography. In nine of these 10 limbs CFDI also showed reflux of this below knee GSV. In four limbs (16%) the varicose veins showed a connection with the small saphenous vein (SSV). In three limbs this reflux was dtected with CFDI after surgery. An IPV was found to be the proximal point of the varicose vein in six limbs (25%) and half of these IPV were detected with CFDI as well. Conclusion: Varicography has less value than CFDI in detecting the source of reflux in patients with recurrent varicose veins after surgery, except in a few cases where IPV are suspected to play a role and CFDI is unable to detect these IPV.

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