A 40-year-old woman visited vascular clinic with complaints of left calf pain and venous engorgement lasted for 6 months. She had previously undergone endovenous laser ablation (EVLA) of the right great saphenous vein (GSV) and left small saphenous vein (SSV) at another hospital. Duplex ultrasonography (DUS) and computed tomography venography (CTV) revealed both vulvoperineal and left SSV refluxes. Three-dimensionally reconstructed CTV images showed a vulvuoperineal varix (a) extending down to the posterior accessory GSV (b) and joining the recanalized GSV above the knee. The right GSV was obliterated owing to the previous EVLA (c). On the left side, the SSV had a reflux at the saphenopopliteal junction (d), extending down and causing an aneurysmal change in the upper SSV (e). Subcutaneous varicose veins (VVs) were prominent on the lateral posterior calf (f), and the mid SSV was obliterated by the previous EVLA (g).
Min et al. [1] described the role of three-dimensionally reconstructed CTV images in VV surgery. CTV can provide an excellent guide for VV surgery without significant complications. It cannot replace DUS but can provide powerful three-dimensional images for designing operations, education, and research. CTV is especially useful for postoperatively recurring VVs with a complex variable anatomy. A comprehensive and easy visualization of abnormal refluxed flow aids in performing a patient-tailored surgery, and also in reducing the recurrence rate. SSV normally has many anatomical variations [2], and CTV can provide detailed preoperative anatomical information.
REFERENCES
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