Imaging

Varicose Veins (Venous Reflux)

Preliminary Diagnosis: Varicose Veins

I. What imaging technique is first-line for this diagnosis?

Ultrasound of the vessel of concern.

II. Describe the advantages and disadvantages of this technique for diagnosing varicose veins.

Advantages

  • Highly portable imaging modality.

  • Does not expose patients to ionizing radiation.

  • Highly adept in detailing the velocity and directionality of the flow of blood within vessels.

Disadvantages

  • Limited in sensitivity and specificity in evaluating the endothelium and valvular structures of the vessel of concern.

  • Less useful in guiding endovascular therapy in patients as compared to catheter angiography.

  • Highly operator dependent.

  • Limited in evaluating the surrounding soft tissues and osseous structures.

III. What are the contraindications for the first-line imaging technique?

No specific contraindications to ultrasound exist.

IV. What alternative imaging techniques are available?

  • CTV imaging.

  • MRV imaging.

  • Catheter angiography all utilizing IV contrast medium.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing varicose veins.

CTV imaging

Advantages

  • Highly sensitive and specific in evaluating the vasculature and detailing any endothelial abnormality.

  • Offers exquisite visualization of the surrounding soft tissues, osseous structures, and vasculature.

  • Highly specific in characterizing any secondary complications.

Disadvantages

  • Exposes the patients to ionizing radiation.

  • Less adept in guiding therapeutic intervention than other modalities.

MRV imaging

Advantages

  • Does not expose patients to ionizing radiation.

  • Offers exquisite detail of the surrounding soft tissues.

  • Moderate in sensitivity and specificity in detecting the vasculature structures and is less sensitive and specific in detailing any endothelial or valvular abnormalities.

Disadvantages

  • Expensive.

  • Time consuming.

  • Subject to motion and susceptibility weighted artifact, degrading image quality.

Catheter angiography all utilizing IV contrast medium

Advantages

  • Gold standard in detecting, characterizing, and diagnosing varicose veins and any vascular endothelial and valvular abnormalities.

  • Offers both diagnostic capabilities and therapeutic access in diagnosing and treating varicose veins and any secondary complications.

Disadvantages

  • Exposes patients to ionizing radiation.

  • Exposes patients to increased morbidity and mortality secondary to the invasiveness of the procedure.

VI. What are the contraindications for the alternative imaging techniques?

CTV imaging

  • May be contraindicated in pregnant patients and those in renal failure not on an adequate dialysis regimen.

  • IV contrast may be contraindicated in patients with renal failure or contrast allergy.

MRV imaging

  • May be contraindicated in patients with non-MR compatible hardware.

Catheter angiography all utilizing IV contrast medium

  • May be contraindicated in patients in a hypocoaguable state.

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