Diagnostic yield of intravascular ultrasound in patients with clinical signs and symptoms of lower extremity venous disease

• Published in: Journal of vascular surgery. Venous and lymphatic disorders (New York, NY) NY), 2020-07, Vol.8 (4), p.634-639
• Main Authors: Saleem, Taimur, Knight, Alexander, Raju, Seshadri
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Angioplasty, Balloon - instrumentation; Chronic venous disease; Endovenous stent; Female; Femoral Vein - diagnostic imaging; Femoral Vein - physiopathology; Humans; Iliac Vein - diagnostic imaging; Iliac Vein - physiopathology; Iliac vein stent; Intravascular ultrasound; IVUS; Lower Extremity - blood supply; Male; Middle Aged; Predictive Value of Tests; Severity of Illness Index; Stents; Treatment Outcome; Ultrasonography, Interventional; Vascular Diseases - diagnostic imaging; Vascular Diseases - physiopathology; Vascular Diseases - therapy
• ISSN: 2213-333X; 2213-3348
• DOI: 10.1016/j.jvsv.2019.10.021

Intravascular ultrasound (IVUS) examination has a higher sensitivity compared with venography in the assessment of obstructive venous disease. However, at most venous centers, both modalities continue to be used concomitantly. This study evaluated the diagnostic clinical yield of IVUS examination as a singular intraoperative investigative modality in patients in whom clinical signs and symptoms of venous disease were severe enough to merit such an examination and in whom a venogram was not performed simultaneously. From January, 2013, to December, 2018, there were 31 limbs (29 patients) who only had IVUS planimetry without concomitant venogram. Clinical parameters such as pain, swelling and Venous Clinical Severity Score were measured preoperatively and postoperatively. The degree of stenosis noted on intraoperative IVUS was compared with the preoperative duplex. Incidence of complications, technical success, and clinical yield of IVUS examination were noted. The etiology of venous lesion was post thrombotic in the majority of patients (74%). All patients (100%) were either in Clinical, Etiologic, Anatomic, and Pathologic class C3 or higher. In all patients (100%) taken to the operating room, IVUS examination identified stenosis in at least one of the following three veins: common iliac vein, external iliac vein, and common femoral vein. Intervention was in the form of angioplasty with endovenous stenting. There was significant improvement in pain, swelling and Venous Clinical Severity Score after the intervention. IVUS is an effective diagnostic tool that displays high quality, real-time cross-sectional anatomy during venous interventions. When used as the sole intraoperative diagnostic modality, it seems to have a high clinical yield in patients in whom signs and symptoms of venous disease are severe enough to merit intervention.