Efficacy of Intravascular Ultrasound over Traditional Venography in Cases of Nonthrombotic Iliac Venous Obstruction

Purpose: To identify and interpret the role of IVUS and its efficacy in diagnosing non thrombotic iliac vein obstruction as compared with traditional digital subtraction venography. To quantify degree of stenosis and anatomic measurements by both the modalities.

Materials and Methods: It is a single centered study conducted at AVBRH wardha, India. All the symptomatic patients as per CEAP classification (CEAP; 4–6) with apparently normal venogram with deep venous refluxes were consecutively enrolled from February 2022 to May 2022. IVUS and venography was performed in each patient. Results and interpretations of both the modalities were compared. IVUS was performed by using POLARIS MULTI-MODALITY GUIDANCE SYSTEM and OPTICROSS 18 peripheral imaging catheter (monorail 0.018). Whole of the iliocaval venous segment was evaluated to localize the exact compression or stenotic site and was compared with real time fluoroscopy. Built in software allowed us to calculate the percentage of stenosis, area and diameter of the venous segment. venography were performed through GSV access, multiple venograms with different projections were obtained (AP, LAO, and RAO) and were recorded at 6 FPS. After interrogating these cine images diameter at the most compressed site (MVD-minimal vessel diameter) and its distal normal segment (RVD-reference vessel diameter) were measured.

Results: A total of 20 participants were included in the study with unilateral effected limb. Age group 21 to 70 years. Mean age group 21 to 30 years with mean age of 38.6 years. Left leg was involved in 14 and right leg was involved in six cases. Consistent with previous studies, a more than 50% diameter stenosis was defined as significant lesions, amongst 20 limbs, IVUS revealed significant stenosis in 19 limbs and not significant in 1 limb. However, 15 out of 19 significant lesions which were diagnosed by the IVUS was missed by the traditional venography. The sensitivity of venography in diagnosing correctly the significant lesion lies near 25% (as per our study)

Conclusion: In our rural population setting, compared with IVUS, traditional venography underestimates the degree of stenosis and also misses the significant obstructive iliac venous lesions. Thus role of IVUS as a relatively newer and safer ultrasound modality can be extended to the diagnosis and treatment of peripheral nonthrombotic iliac venous outflow obstructions accurately and effectively.

 

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Publication History

Article published online:
02 April 2024