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

Purpose: Computed tomography venography (CTV) with three-dimensional reconstruction can provide complementary road maps for varicose vein (VV) surgery. The purpose of this study is to verify the role of CTV in the treatment of VV in terms of advantages and complications. Methods: Ninety-four consecutive patients with VV underwent conventional high ligation, stripping, and varicosectomy by a single vascular surgeon in 2007. All patients were evaluated with duplex ultrasound and CTV. Patients with renal dysfunction, allergy to radiocontrast, telangiectasia only, or treated by endovenous laser therapy (EVLT) were excluded from the study. Computed tomography (CT) examination was performed with a 16-Multidetector CT scanner (Siemens, Erlangen, Germany) and 3D images were reconstructed by personal computer-based software (Rapidia, Infinitt, Seoul, Korea). Medical records and the CT images were reviewed retrospectively. Results: VV surgeries were done in 127 limbs of 94 patients (both in 33, right in 29, and left in 32). There were 56 females and 38 males with the mean age of 57 years (range, 28-79 years). The CEAP classification was C_2-3 EpAsPr. Perforators larger than 1 mm near the varicose veins were detected and marked on the CT volume-rendering images. The average numbers of perforators marked by CTV were 12.07 ± 4.27 in each limb. The perforators were evaluated by duplex for the presence of reflux (≥0.5 sec). Mean number of perforators with reflux in each limb was 1.41 ± 1.67, which were ligated during the surgery. Incidental detections of other disease were done in six patients, including uterine myomas, an ovarian cyst, a gallstone, a scrotoal varicocele, and a pes anserine bursitis. Operation was performed with the CTV images on screen. CTV was helpful in designing the operation in most patients. Three-D CTV images of saphenopopliteal junction especially provided thorough understanding of the complex variable anatomy of the lesion. There were no CT-related complications, such as renal dysfunction or allergic reaction. Conclusions: CT venography can provide excellent road map for VV surgery without significant complications. It cannot replace duplex ultrasound, but can provide powerful 3D images for designing operation as well as education and research.