Dimensional disparity between duplex and intravascular ultrasound in the assessment of iliac vein stenosis

Abstract

Minimum iliac vein caliber necessary to maintain normal peripheral venous pressure can be derived by the Poiseuille equation. Duplex was compared to intravascular ultrasound (IVUS) in the assessment of iliac vein stenosis in this single center retrospective study. Parallel IVUS and duplex caliber data for common iliac vein (CIV) and external iliac vein (EIV) in 382 limbs were separately compared. One or both segments were stenotic by IVUS criteria in 213 limbs. Neither segment was stenotic by IVUS in 22 limbs. Bland–Altman analyses and Passing–Bablok linear regressions were used. Duplex calibers were dimensionally smaller than corresponding IVUS images of CIV and EIV segments in Bland–Altman comparison by a mean of 54 mm2 and 34 mm2, respectively. Passing–Bablok regression suggested the difference was due to a systematic bias and not proportional. Duplex yields a smaller cross-sectional image of CIV and EIV compared to IVUS. Duplex is not a reliable diagnostic test for iliac vein stenosis.

Intravascular Ultrasound in Treating Iliac Vein Compression With Endovascular Stenting: A Necessary Tool for Optimal Outcomes

“…The IVUS was able to depict a double compression in the common and the external iliac vein in both cases and should be considered the gold standard for diagnosing and for operative planning of MTS. 7-9…”

“…11 Nevertheless, DUS has been shown to be a less reliable diagnostic test for iliac vein stenosis as it yields a smaller cross-sectional image of CIV and EIV compared to IVUS. 7 Furthermore, venography has been shown to be less accurate compared to IVUS regarding the location of the iliac stenosis and the ilio-caval confluence, as well as the distal landing zone when planning for stent placement. 12,13 In contrast, IVUS can accurately determine the patency of the LCIV and identify MTS anatomy, and it is invaluable in determining the extent of thrombus occlusion in cases with DVT and the degree of vessel stenosis, assisting with stent sizing and appropriate stent apposition and deployment.…”

“…The IVUS was able to depict a double compression in the common and the external iliac vein in both cases and should be considered the gold standard for diagnosing and for operative planning of MTS. [7][8][9] The classic MTS is due to LCIV compression between the RCIA and spinal vertebrae. 1 Atypical cases of MTS including compression of the left external iliac vein, right iliac vein or the IVC, some of them depicted on DUS causing double vein compression have been reported in the literature.…”

“…Intravascular ultrasound is invaluable in re-canalizing chronic vein occlusions, localizing the iliac venous obstruction sites, making vein diameter measurements more precise, and assisting in accurate deployment of vein stents. 1,7,8…”

“…Intravascular ultrasound is invaluable in re-canalizing chronic vein occlusions, localizing the iliac venous obstruction sites, making vein diameter measurements more precise, and assisting in accurate deployment of vein stents. 1,7,8 Treatment of MTS with venoplasty and stenting of the underlying stenotic lesion is typically reserved for symptomatic patients while those with DVT will benefit from beforehand clearance of the thrombus via pharmacomechanical thrombolysis/thrombectomy. 1,2,4,9,10 Such endovascular therapies, when used in combination with anticoagulation, have demonstrated favorable outcomes in patients with MTS.…”