Three-dimensional spiral CT venography for the pre-operative assessment of varicose patients

The purpose of pre-operative spiral CT venography or veno-CT (VCT) is to provide a precise 3D anatomic depiction of the venous network, to be used as a guideline by the surgeon.

A multislice and multidetector spiral CT acquisition of the lower limb with diluted contrast injection produces about 400 slices in 30 s. Dedicated volume-rendering software compute interactive 3D images of the venous system. Dynamic data are easily exported by e-mail and available for phlebologists and surgeons. As VCT provides no hemodynamic data, an associated color-coded duplex is mandatory.

VCT is useful in case of post-operative recurrence (especially of the popliteal fossa), high or dystrophic termination of the short saphenous vein, varices feeded by the Giacomini vein, and to investigate pelvic or pudental varicose veins. A full knowledge of the complex venous networks is possible thanks to interactivity of the resulting 3D model, using rotation and modification of transparency of the tissues.

Providing a more complete anatomical information, VCT makes possible a better surgical choice of technique, avoiding anatomic pitfalls, with a more precise and limited skin approach. Accordingly, it may hopefully improve the aesthetic result as well as the efficacy, by reducing the varicose veins recurrence rate.