Intravascular Ultrasound Use Is Associated With Decreased Thrombosis After Deep Venous Lower Extremity Interventions
Sahar Ali1, Paula Pinto Rodriguez2, Ehsan Abualanain2, Mostafa S Khalil1, Hesham Aboloyoun1, Juan Carlos Perez Lozada2, Edouard Aboian2, Robert Attaran2, Cassius Iyad Ochoa Chaar2.
1Assiut Faculty of Medicine, Assiut, Egypt, 2Yale University, New Haven, CT, USA.
OBJECTIVES: Intravascular ultrasound (IVUS) is the gold standard for the diagnosis and sizing of venous stents. However, the impact of IVUS use on thrombosis after deep venous interventions has not been extensively studied. This study assesses the impact of IVUS on thrombosis after deep venous lower extremity interventions for various indications. Our hypothesis is that the use of IVUS is associated with decreased risk of venous thrombosis. METHODS: A retrospective study of consecutive patients undergoing deep venous lower extremity interventions was performed at a single institution between 2013-2021. Patients were divided into 2 groups based on the use of IVUS during the procedure. Patient characteristics and outcomes including early and late thrombosis were compared.
RESULTS: A total of 181 patients (73% with IVUS) were analyzed. Patients treated with IVUS were more likely to be females and have chronic obstructive pulmonary disease and chronic kidney disease. Patients treated without IVUS were more likely to be white and have a hypercoagulable condition. Patients treated with IVUS were more likely to undergo an outpatient procedure but less likely to undergo general anesthesia. The IVUS group was more likely to be treated with stenting for non-thrombotic disease and less likely to have deep vein thrombosis on initial presentation. The Wallstent (Boston Scientific inc, MA) was the stent most commonly used in both groups. However, patients treated with IVUS were more likely to undergo the implantation of novel dedicated venous stents. Patients treated without IVUS were significantly more likely to develop early thrombosis with no difference in bleeding between the 2 groups. After a mean follow-up of 391 days, there was no difference in the proportion of patients who experienced clinical improvement between the 2 groups but patients treated without IVUS had significantly lower patency compared to patients treated with IVUS. CONCLUSIONS: IVUS use is associated with decreased early as well as late thrombosis after deep venous interventions.
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