(Circulation. 2000;102:e33.)
© 2000 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Three-Dimensional Phlebography of the Saphenous Venous System
From the Departments of Anatomy (A.C.) and Radiology (G.L.), University of Rome La Sapienza, and the Department of Radiology, University of Parma (P.P.), Italy.
Correspondence to Alberto Caggiati, MD, PhD, Department of Anatomy, University of Rome La Sapienza, Via A. Borelli 50, I-00161, Rome, Italy. E-mail caggiati{at}uniroma1.it
The saphenous venous system was visualized by CT without any contrast medium injection. Volumetric data were acquired with a multidetector spiral CT (Siemens, Somatom Plus 4 Volume Zoom) with the following parameters: collimation, 1 mm; pitch, 4; reconstruction, 1.2 mm. Reformatted images were then transferred in DICOM format to an 02 work station (Silicon Graphics) and postprocessed by the software VITREA 1.2 (Vital Images). 3D images were evaluated by means of the volume-rendering technique (VRT).
VRT-CT allows an excellent morphological demonstration of size, path,
and connections of the saphenous trunks and of their tributaries, even
if no contrast medium is injected (Figure 1A
). To the best of our knowledge, VRT-CT
has never been used in the morphological evaluation of the saphenous
venous system.
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The spatial arrangement of superficial veins is preserved and clearly
demonstrated so that with real-time postprocessing, it is possible to
observe them from any angulation. In fact, as clearly shown by CT and
sonography (Figure 1
, B and C), saphenous veins occupy a deep
position in the hypodermis, lying just above the muscular fascia. They
are anchored to the muscular fascia by means of the saphenous
fascia.1 Saphenous tributaries course in superficial
hypodermic layers and become deeper only as they flow into the
saphenous vein.
In varicose limbs, VRT-CT allows an easy discrimination of dilated and
tortuous venous trunks from those with a normal caliber (Figure 2, A). In most varicose limbs, the
"saphenous fascia"2 protects saphenous veins from
greater varicose changes (Figure 2, B and C). In fact, at the
level of varicose tributaries, a saphenous vein of regular caliber is
frequently seen (Figure 2, A, B, and C) and is better shown by
stereo-pair photographs (Figure 3).
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Only when the deep venous system needs to be evaluated is contrast medium injection necessary.
Footnotes
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
References
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Caggiati A, Ricci S. The long saphenous vein
compartment. Phlebology. 1997;12:107–111.
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Caggiati A. The fascial relationships of the long
saphenous vein. Circulation. 1999;100:2547–2549.
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