Application Of Computed Tomography Venography In The Diagnosis Of Chronic Venous Disease Of Lower Extremity

Part One Comparative analysis of computed tomography venography (CTV)with digita substraction angiography(DSA)and Doppler ultrasound(DUS)in chronic venous diseases(CVD)of lower extremities.Objective:To evaluate the application of CTV,DSA and DUS in the diagnosis of CVD,especially iliac vein compression.Methods:1.The clinical data of 78 patients with lower extremity CVD admitted to the vascular science of the First Hospital of Hebei Medical University from April 2015 to May 2016 were collected.All patients underwent CTV,DSA and DUS.The differences were compared in terms of operation time,blood flow force and structural function of venous diseases.2.Data were analyzed using statistical software SPSS 22.0,and the measurement data were expressed as mean ± standard deviation.Two or more classification and count data were analyzed by χ2 test,and difference between groups was analyzed by t test(for parametric variables).P<0.05 was statistically significant.Result:The operating time of CTV(15.4 ± 1.9 min)was shorter than DSA(28.2 ± 1.9 min)and DUS(24.2 ± 2.0 min)(P < 0.001).For the reason of IVCS,only CTV(48/78)can diagnose.DSA and DUS can not diagnose,but CTV cannot be clearly diagnosed.For the reflux of venous system,CTV could not diagnose.Conclusion: DUS is recommended for the diagnosis of hemodynamics in CVD of lower extremity.CTV is recommended for structural histology.DUS is the first choice for diagnosis of CVD.CTV can identify obstructive lesions of the iliac-vena and deep venous system of the lower extremities.The combination of DUS and CTV can effectively diagnose CVD.Part Two IVCS diagnosed with CTV and analysis of risk factors of IVCSObjective: To explore the imaging criteria of CTV for the diagnosis of iliac vein compression and the clinical factors affecting the incidence of iliac vein compression.Method:1.The clinical imaging data of 120 patients with CVD and 68 patients with non-CVD who were admitted to the vascular science of the First Hospital of Hebei Medical University from April 2015 to May 2016 were collected.All patients underwent CTV.CTV imaging was used to establish the standard of iliac vein compression,clinical data were collected,and relevant factors affecting the occurrence of iliac vein compression were analyzed.2.Data were analyzed using statistical software SPSS 22.0,and the measurement data were expressed as mean ± standard deviation.Two or more classification and count data were analyzed by χ2 test.The measurement data were analyzed by T-test.Multivariate logistic regression was used to analyze the risk factors affecting the incidence of iliac vein compression.The correlation analysis was performed using the Bivariate.Spearman coefficient was calculated,and P < 0.05 was considered statistically significant.Result:1.The incidence of venous compression in the CVD group(64/120,53.3%)was higher than that in the non-CVD group(15/68,22.1%),and the difference was statistically significant(χ2=17.425,P<.001).2.The incidence of female iliac vein compression(29/40,72.5%)was significantly higher than that of male(35/80,43.75%),the difference was statistically significant(χ2=8.856,P=.003).The incidence of venous compression was significantly higher in patients with stimulating history(14/80,17.5%)than in patients without cold water stimulation((2/80,2.5%),the difference was statistically significant(χ2=8.569,P=0.003).With the prolongation of CVD,the incidence of iliac vein compression increased(P=0.020).Multivariate Logistc regression analysis showed that women and CVD duration were the risk factors for the incidence of iliac vein compression(P<0.05).3.The course of disease was positively correlated with the degree of iliac vein compression,and the difference was statistically significant(r=0.321,P<0.05).As the course of CVD is prolonged,the degree of compression of the iliac vein is gradually increased.Conclusion: Patients with CVD are more likely to have iliac vein compression.The long course of CVD and women are probablely risk factor affecting the incidence of iliac vein compression.As the CVD course is prolonged,the severity of iliac vein compression is aggravated.Part Three Application of CTV in the recurrence of varicose veins of lower extremitiesObjective:CTV were used to analyze the related factors of recurrence of varicose veins after surgery(REVAS)in lower extremities.Method:1.Clinical data of 54 patients who underwent recurrent varices after surgery(REVAS)from April 2015 to October 2016 in the vascular science of the First Hospital of Hebei Medical University were collected.All patients received CTV and DUS.Analysis of postoperative recurrence differences in three different surgical methods of varicose veins,clinical symptoms of REVAS,and related factors affecting REVAS.2.Statistical analysis Data processing using SPSS 22.0,measurement data expressed as mean ± standard deviation(`x ± s),comparison using analysis of t test,correlation analysis using pearson method,| r | > 0.3 considered relevant,P < 0.05 was statistically significant.Result:1.Male(42/54,77.8%)is more than female(12/54,22.2%),family history of varicose veins(31/54,57.4%)was the main reason for REVAS.The main clinical symptoms were pain(28/54,51.9%),fatigue(27/54,50%),heavy(21/54,38.9%),and cramps(14/54,25.9%).There was no significant difference in the different surgical methods(P > 0.05).2.Body mass index(BMI)was negatively correlated with the time of REVAS,and the difference was statistically significant(P<0.001).The recurrence time of iliac vein compression was significantly shorter than that of the non-iliac vein compression.The difference was statistically significant(T=2.016,P=0.020).The recurrence time of the deep venous reflux group was significantly shorter than that without deep venous reflux,the difference was statistically significant(T=-3.580,P=0.001).Conclusion: The family history of varicose veins is the primary cause of REVAS.The clinical manifestations of REVAS patients are mainly pain and fatigue.There was no significant difference in the recurrence time of three surgical methods.BMI was negatively correlated with REVAS time,and patients with iliac vein compression and deep venous reflux were more likely to develop REVAS.Part Four CTV diagnosis of IVCS combined with analysis of venous leg ulcer treatmentObjective: To investigate the ulcer healing of patients with IVCS with venous ulcer(VU)diagnosed by CTV after iliac vein stent implantation.Method:1.Clinical data of 24 cases of venous active ulcer(C6)of the lower extremity admitted to the vascular science of the First Hospital of Hebei Medical University from April 2015 to May 2016 were collected.All patients underwent CTV and the clinical data were complete.6 of the 14 patients with IVCS underwent iliac vein stent placement,and the healing time of postoperative ulcers in different groups was compared.2.Data processing using SPSS 22.0,measurement data expressed as mean ± standard deviation(`x ± s),the clinical parameters of venous leg ulcers were compared using the rank sum test of multiple independent samples,ulcer healing time using K-M survival analysis Statistics were performed,and P < 0.05 was considered statistically significant.Result:1.Of the 24 patients,CTV diagnosed 10 cases of NIVCS(group A)and 14 cases of IVCS.Of the 14 patients with IVCS,6 underwent iliac vein stent(group B),and 8 underwent iliac vein stent(group C).The ulcer healing rate of group B was higher than group A and group C.There was no significant difference in ulcer survival time between group B and group C(χ2=1.287,P=0.257).The ulcer survival time of group B and group C was significantly shorter than group A(χ2=12.635,P=0.002).2.DUS reviewed the patency rate of the iliac vein stent.The patency rates of the 6 patients at 3 months,6 months,and 12 months were 100.0%,100.0%,and 83.3%,respectively.One patient was recived iliac vein stent again because of the recurrence of occlusion at the end of the stent.The ulcer was healed 24 days after surgery.Conclusion: IVCS diagnosed of CTV with iliac vein stent is effective in promoting the healing of VU,and is an effective method for the treatment of VU.