3D venous anatomy of the venous network of the lower limb

Abstract

Introduction: The aim of this work is to build a new educational tool to better understand venous anatomy of the lower limbs by the help of embryology, Duplex color assessment and 3d modeling by CT venography (CTV)

Materials and methods: Pictures of anatomical drawings from the Atlas book of Gillot [1] are illustrated and enhanced by the new imaging techniques of the venous system: 3D venography [2–5] and Color Duplex [6].

A multislice with 64 detectors spiral CT acquisition of the lower limb with contrast injection of the foot produces about 800 slices of the whole limb in 40 seconds.

Image processing is done by VRT technique with 2 free softwares running on Macs: Osirix® [www.osirix.com] and Horos® [www.oros.com]

Results: Interactive 3d modes are built in real time and movie files of a 360 degres rotation of this 3D model are easily exported to quicktime format.

 • Easy learning of the superficial venous network, perforators and their connection to the deep system, with the help of embryology

• Explanation of the 3 venous compartments of the sural nerve pedicle and hemodynamics of the GSV and SSV termination

• Pre-operative surgical assessment of complex /redo varices and congenital vascular malformations in addition to US Duplex and MRI.

Discussion and conclusions: The VCT is a powerful tool to investigate the venous system of our patients with chronic venous disease, but it is providing no hemodynamical data, so an additional DUS (color duplex) is mandatory. It makes possible a virtual dissection of the limb, which gives an accurate and interactive 3d map of the whole limb in addition to the landmarks provided by the DUS skin marking before treatment.

A lesson of anatomy is proposed, illustrated by a full Interactive use of 3D models. and illustrated by case reports with « virtual dissection » of the patients.