3d imaging of - cacvs.orgcacvs.org/pdf/presentations/2018/27-01-2018/roomb/0919-uhl_jean...revas 1...
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3d IMAGING ofextrinsic deep venous compression
Jean-François UHL MD, FacPhParis Descartes University – Research Director UNESCO Chair of digital Anatomy
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Extrinsic compression by arteries
I have no conflict of interest
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To uncover a cause of CVD…
§ Deep venous obstruction is frequently hidden
and not easily highlighted by USD
§ Ivus is expensive and ineffective below the groin
Assessment of the whole deep veins by
CT-VENOGRAPHY should be done in more cases
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• Direct or indirect MSCTV• Interactive 3d model • Whole venous network• No hemodynamical data • Duplex mandatory
MSCT-Venography technique*
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* Gaweesh, Davies et al. Phlebology 2015 2013;28:426–431
Underlying deep venous abnormalitiesin patients with unilateral CVD*
• In a series of 8 unilateral « primitive » CVD
• Deep vein obstruction was detected in all limbs
with a normal controlateral limb.
• Not only in iliac location
• Independant of DV reflux
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Deep venous compressionby arteries (pseudo May-Thurner sd)personnal series of 10 cases in 2017
Case reports with 3D imaging of
frequent & under-diagnosed +++
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“classical” May-Thurner Syndrome
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Other common ilio-caval compressions
1:High crossing of RCIA2: classical compression by RCIA
3: compr. by LCIA 4: compr. REIAL= inguinal Ligament
(from Lea Thomas)
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Case report 1
C4a
CTV: synechia +stenosis of RCIV
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REVAS 1 year after SSV surgery
SYSTOLIC reflux of SSV thumb
Vicarious shunt by arcades of SM
Case report 2
CTV: synechia +stenosis of RCIV
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Case report 2
CTV: synechia +stenosis of RCIV
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Man of 70 Y not treatedHuge leg PVsBelow knee
Case report 3
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Case 4: LCIV compressionby lumbar arthrosis
Case of post-op edema appeared 6 monthafter a surgery for uterus CancerCompression by a metastatic node ?
The compression shown here is NOTa metastatic nodebut the inprint lombo-sacral disc on the vein
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Pelvic leak pointsmost common are P and O points
related to deep vein compression & under-investigated
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Case report 5P point
Alcock canal
P point
Compression of IVC by a high RCIA
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Conclusion
It is likely that these deep venous abnormalities,
permanent or positional are not so rare.
Obstructive syndromes are underdiagnosed.
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Conclusion (2)
We have to keep in mind that the so called "primitive CVD"
could be secondary to deep venous compression by
arteries …
So, we should more frequently investigate the patients by
CT-Venography which provides a full 3D depiction of the
whole deep system anatomy.
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DVD of venous anatomy & ATLAS of GILLOT (www.jfuhl.com)
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MULTIMODAL VENOUS IMAGINGMasterclass … in Paris
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