Direct 3D rotational venography: Insights in optimizing visualization

IntroductionThree-dimensional rotational venography (3D-RV) expands on three-dimensional rotational angiography to provide high-quality venous anatomy details, complementing traditional two-dimensional digital subtraction angiography and supporting the diagnosis and treatment of venous pathologies. This article presents a series of patients who underwent advanced 3D-RV for the evaluation of idiopathic intracranial hypertension (IIH).MethodsIn this single-center retrospective case series, we analyzed 13 patients with IIH who underwent direct 3D-RV from June 2023 to May 2024. Access was obtained by placing a 6-Fr or larger guide catheter in the rostral internal jugular vein, with a Zoom 35 microcatheter advanced to the middle third of the superior sagittal sinus. A descriptive analysis was performed based on the demographic and radiation metrics.ResultsSixteen direct 3D-RV procedures were performed on 13 patients with IIH (mean age 42.06 ± 13.13 years), including 10 females and three males. General anesthesia was administered for interventions (12 cases) and monitored anesthesia care for manometry (four cases). Venous access was obtained via upper extremity veins in 13 cases (81.25%) and the right common femoral vein in three cases (18.75%). Mean fluoroscopy time was 42.0 ± 29.8 min, contrast dose 92.2 ± 34.2 mL, dose area product (DAP) 18.6 ± 10.5 Gy·cm², and air kerma 1.3 ± 0.56 Gy, with a mean procedure time of 71.3 ± 42.0 min. The 3D-RV procedure contributed an additional 1.86 ± 0.6 Gy to DAP and 0.072 ± 0.021 Gy to air kerma, representing an extra 6.26% and 10.59% of the skin dose, respectively. No procedure-related or in-hospital complications occurred.ConclusionsThe 3D-RV procedure is reliable and safe, offering improved accuracy in assessing venous anatomy and stents without significantly impacting procedure time or radiation dose.