To report our initial experience using direct multidetector computed tomography venography (MDCT-V) for imaging lower limb deep veins. CT findings in limbs with chronic venous disease (CVD) were compared with contralateral healthy limbs.

MDCT-V with bilateral direct pedal injection of contrast was used to image the deep veins in both lower limbs. Eight patients with unilateral lower limb CVD of varying severity (according to the Clinico-Etiological-Anatomical and Pathological classification [CEAP] class 2-6) were studied. Five patients had primary CVD, while three patients had CVD secondary to previous deep vein thrombosis.

Deep venous obstruction (>50%) or occlusion was identified in all CVD limbs and was not seen in contralateral healthy limbs. These lesions were not only iliac, were not exclusively present in advanced CVD and were independent of the presence or absence of deep venous reflux.

Morphologically significant lesions could be underlying in patients with clinically significant CVD. Direct MDCT-V provides clear reconstructable cross-sectional images of the whole deep venous tree, including infrainguinal areas, beyond the reach of intravascular ultrasound. Utilization of new venous imaging modalities may uncover previously undiagnosed and potentially treatable venous pathology in patients with CVD.