2016 Volume 27 Issue 3 Pages 267-273
Objective: We preoperatively assessed varicose veins by means of noncontrast three-dimensional CT venography (noncontrast 3DCTV) in the great saphenous vein area of the lower extremity. The goal of this study was to analyze the site, source, and contributory fators of recurrent varices after surgery (REVAS). Methods: 712 patients of varicose veins have been operated in our clinic from January 2011 to February 2015. Preoperative noncontrast 3DCTV was performed in 59 patients undergoing stripping (ST) or endovenous laser ablation (EVLA). The images were reconstructed with the volume-rendering method. We evaluated saphenofemoral junction (SFJ) branch, duplicated GSV and Neovascularization. Results: Noncontrast 3DCTV clearly visualized the superficial veins in the GSV area. With analyzing noncontrast 3DCTV, we could categorized SFJ branch patterns and recognized duplicated GSV which connected with thigh perforator. It was considered that Type2 (high accessory saphenous vein [ASV] type: 49.2%) and Type3 (common trunk type: 22.0%) have risk factors for future reflux in ASVs. The duplicated GSV associated with REVAS existed in 30.5% of all cases. Superficial epigastric vein (SEV), superficial circumflex iliac vein (SCIV) and stump of GSV had become the source of neovascularization after GSV ST. Conclusions: Diagnosis by using Duplex ultrasound is necessary in all cases of varicose veins. Compared with using only Duplex ultrasound, noncontrast 3DCTV makes us understand the form of superficial vein in more detail, which have contributory factors of recurrence and neovascularization in groin. Noncontrast 3DCTV is useful in the preoperative strategy of varicose vein, specifically in order to prevent REVAS.
