Comparative study between the use of intravascular ultrasound versus conventional venography in management of iliofemoral chronic venous insufficiency

Ashour, Mahmoud F.M.; Ahmed, Abd El Rahman M.; Kamel, Amr N.; Essam Eldin, Sherif M.; SaadEldin, Ahmed M.; Mohamed Zaki, Mohamed M.

doi:10.4103/ejs.ejs_267_20

Comparative study between the use of intravascular ultrasound versus conventional venography in management of iliofemoral chronic venous insufficiency

Authors

Abstract

Objective
The current study was carried out to reveal the added value of intravascular ultrasound (IVUS) in the diagnosis, clinical decision, and subsequent outcomes of the treatment of iliofemoral chronic venous insufficiency, relative to contrast multiplanar venography.
Patients and methods
This is a prospective randomized study encompassing 40 patients with symptomatic chronic venous insufficiency. Patients were randomly stratified into two groups; 20 patients were randomized into exclusively having multiplanar venography, and the other group would have IVUS in addition to completion venography to guide the intervention.
Results
Both the duration of the procedure and amount of contrast injected were significantly higher in the venography group (=0.014 and <0.0001, respectively). Postoperative creatinine was significantly less in the IVUS group (<0.0001), and the mean increase in serum creatinine was significantly higher in the venography group (<0.0001). Target lesion revascularization was significantly higher in the venography group (=0.002). IVUS detected a mean of 2.75 significant lesions compared with a mean of 1.6 lesions detected through venography (<0.001) and was more able to detect stenoses and occlusions than computed tomography venography during follow-up, with a value of 0.018. IVUS group showed a statistically significant higher primary assisted patency rate compared with venography, with a value of 0.017.
Conclusion
IVUS is one of the most effective tools in the armamentarium of a vascular surgeon and interventionalist, especially when dealing with venous disorders. Our study suggests that as an imaging modality, it provides more sensitive and accurate details of the lesion, aids in setting a more appropriate plan, guides the surgeon through a more precise sizing and deployment of the necessary stents, and finally, provides a better follow-up tool to detect and guide subsequent interventions, resulting in higher primary assisted and secondary patency rates.

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