Differences in anatomic targets between venogram and intravascular ultrasound in the setting of iliofemorocaval stenting
Ignatius Lau, MD, C. Y. Maximilian Png, Meghana Eswarappa, Michael Miller, Michael Marin, MD, Peter Faries, MD, Windsor Ting, MD.
Mount Sinai Hospital, New York, NY, USA.
OBJECTIVES: Previous studies have shown limited sensitivity of venography compared to IVUS but few studies have analyzed the discrepancies by anatomic location. We report our experience with venography and IVUS and their determination of anatomic targets for iliofemorocaval stenting.
METHODS: A series of 97 consecutive patients who underwent both IVUS and venography and additionally received iliofemorocaval stenting from 2014 to 2016 were reviewed. The location of the lesions detected and stents placed were recorded.
RESULTS: Overall, 94/97 and 96/97 patients had left lower extremity and right lower extremity venogram and IVUS, respectively. Lesions identified on IVUS that were not detected on venogram changed management in 81/94 (86%) of left lower extremities and 67/96 (70%) of right lower extremities. Lesions identified on venogram that were not detected on IVUS changed management in 1/94 (1%) of left lower extremities and 1/96 (1%) of right lower extremities. On the left, 68/81 (84%) common iliac vein (CIV), 28/81 (35%) external iliac vein (EIV), and 18/81 (22%) common femoral vein (CFV) lesions were detected on IVUS but not on venogram. On the right, 32/67 (48%) CIV, 26/67 (39%) EIV, and 13/67 (19%) CFV lesions were detected on IVUS but not on venogram. Left-sided stents were placed in the IVC in 58/94 (62%), CIV in 64/94 (68%), EIV in 45/94 (48%), and CFV in 29/94 (31%) of patients based on IVUS imaging that would otherwise not have been placed based on venogram. Right-sided stents were placed in the IVC in 3/96 (14%), CIV in 38/96 (40%), EIV in 29/96 (30%), and CFV in 27/96 (28%) of patients based on IVUS imaging that would otherwise not have been placed based on venogram. The sensitivity of venogram compared to IVUS in the left CIV, EIV, and CFV was 7%, 47%, and 42% compared to 22%, 40%, and 38% on the right. Overall, sensitivity was 27% for venogram compared to IVUS when combining all lesion locations.
CONCLUSIONS: Within the subset of chronic venous disease patients who require stenting, intravascular ultrasound identifies lesions not found on venography and significantly alters the treatment plan in the majority of cases.
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