Venography versus intravascular ultrasound for diagnosing and treating iliofemoral vein obstruction

Gagne, Paul J.; Tahara, R.; Fastabend, C.; Dzieciuchowicz, Łukasz; Marston, William A.; Vedantham, Suresh; Ting, Windsor; Iafrati, Mark D.

doi:10.1016/j.jvsv.2017.04.007

Cited by 181 publications

(121 citation statements)

References 22 publications

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“…However, May and Thurner, in their original autopsy study described its presence in one‐fifth of all cadavers . With increasingly sensitive techniques like IVUS to identify iliac compression, diagnoses are made more frequently and in a more diverse cohort of patients, yet the finding's correlation with clinical VTE is not well established . One case–control study of 230 patients demonstrated only a signal for increased left‐sided DVT when the degree of stenosis exceeded 70% of vessel diameter on CT venography …”

Section: Discussionmentioning

confidence: 99%

“…8 With increasingly sensitive techniques like IVUS to identify iliac compression, diagnoses are made more frequently and in a more diverse cohort of patients, yet the finding's correlation with clinical VTE is not well established. 9 One case-control study of 230 patients demonstrated only a signal for increased left-sided DVT when the degree of stenosis exceeded 70% of vessel diameter on CT venography. 10 A landmark analysis in 2009 connected cryptogenic stroke with evidence of IVCS on magnetic resonance venography, suggesting that the anatomic abnormality predisposes to embolic phenomenon in the right substrate.…”

Section: Ivcs Eponymously Known As May-thurner Syndrome Ormentioning

confidence: 99%

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Acute pulmonary embolism unmasking underlying chronic thromboembolic pulmonary hypertension and iliac vein compression syndrome

Brener

Parikh

Sethi

2019

Cathet Cardio Intervent

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We describe the case of a 72‐year‐old gentleman who was referred to our institution for management of cardiogenic shock from a massive pulmonary embolism. Right heart catheterization revealed a low cardiac index and markedly elevated pulmonary pressures, suggested long‐standing venous thromboembolic (VTE) disease that evolved into chronic thromboembolic pulmonary hypertension (CTEPH). The patient was cannulated to veno‐arterial extra‐corporeal membrane oxygenation and eventually treated with pulmonary embolectomy and thromboendarterectomy. Subsequently discovered inferior vena cava clot and left iliac deep vein thrombosis were treated with suction and mechanical thrombectomy. Intravascular ultrasound of the left lower extremity venous system identified iliac vein compression syndrome (IVCS) as the culprit of the patient's VTE and CTEPH. A left iliac stent was placed and the patient was discharged on Warfarin for anticoagulation. The case illustrates the rapidly expanding armamentarium for VTE treatment and proposes IVCS as a new, potentially underrecognized risk factor for CTEPH.

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Section: Discussionmentioning

confidence: 99%

Section: Ivcs Eponymously Known As May-thurner Syndrome Ormentioning

confidence: 99%

Acute pulmonary embolism unmasking underlying chronic thromboembolic pulmonary hypertension and iliac vein compression syndrome

Brener

Parikh

Sethi

2019

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…MRI or CT venography can be used for more detailed visualisation of the abdominal and pelvic veins; our group prefers MRI as it reduces radiation exposure avoids the need for intravenous contrast agents. Invasive assessment with contrast venography has long been considered gold standard for identification of venous outflow obstruction and visualisation of collateral pathways; however, intravascular ultrasound has more recently been demonstrated to have a superior sensitivity and specificity for identification of iliac vein lesions [41].…”

Section: Diagnosis Of Iliocaval Venous Obstructionmentioning

confidence: 99%

Iliocaval Venous Obstruction, Cardiac Preload Reserve and Exercise Limitation

Morris

Sobotka

Balmforth

et al. 2020

J. of Cardiovasc. Trans. Res.

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Cardiac output during exercise increases by as much as fivefold in the untrained man, and by as much as eightfold in the elite athlete. Increasing venous return is a critical but much overlooked component of the physiological response to exercise. Cardiac disorders such as constrictive pericarditis, restrictive cardiomyopathy and pulmonary hypertension are recognised to impair preload and cause exercise limitation; however, the effects of peripheral venous obstruction on cardiac function have not been well described. This manuscript will discuss how obstruction of the iliocaval venous outflow can lead to impairment in exercise tolerance, how such obstructions may be diagnosed, the potential implications of chronic obstructions on sympathetic nervous system activation, and relevance of venous compression syndromes in heart failure with preserved ejection fraction. Preload Reserve and Venous ReturnPreload reserve describes the dependence of cardiac output on venous return to the heart, independent of heart rate and contractility, and is a critical feature of how the body responds to changes in posture and exercise. Increased heart rate, vasoconstriction, and cardiac inotropy are well-described features of the baroreceptor-mediated responses to standing and exercise; however, the principal mechanism for increasing stroke volume is best explained by the ventricular function curves

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“…Volumetric reconstruction may help delineate location and extent of obstruction and involvement of collateral pathways . Intravascular ultrasound can also provide high‐quality cross‐sectional imaging of focal venous segments and may add critical information regarding pathophysiology (eg, compression, wall thickening, or perivenous fibrosis) and the response to therapeutic interventions (eg, recoil following venoplasty) …”

Section: Failure Points and Essential Components Of Carementioning

confidence: 99%

Evidence‐Based Strategies and Recommendations for Preservation of Central Venous Access in Children

Baskin

Mermel

Saad

et al. 2019

J Parenter Enteral Nutr

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Children with chronic illness often require prolonged or repeated venous access. They remain at high risk for venous catheter–related complications (high‐risk patients), which largely derive from elective decisions during catheter insertion and continuing care. These complications result in progressive loss of the venous capital (patent and compliant venous pathways) necessary for delivery of life‐preserving therapies. A nonstandardized, episodic, isolated approach to venous care in these high‐need, high‐cost patients is too often the norm, imposing a disproportionate burden on affected persons and escalating costs. This state‐of‐the‐art review identifies known failure points in the current systems of venous care, details the elements of an individualized plan of care, and emphasizes a patient‐centered, multidisciplinary, collaborative, and evidence‐based approach to care in these vulnerable populations. These guidelines are intended to enable every practitioner in every practice to deliver better care and better outcomes to these patients through awareness of critical issues, anticipatory attention to meaningful components of care, and appropriate consultation or referral when necessary.*

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Venography versus intravascular ultrasound for diagnosing and treating iliofemoral vein obstruction

Cited by 181 publications

References 22 publications

Acute pulmonary embolism unmasking underlying chronic thromboembolic pulmonary hypertension and iliac vein compression syndrome

Acute pulmonary embolism unmasking underlying chronic thromboembolic pulmonary hypertension and iliac vein compression syndrome

Iliocaval Venous Obstruction, Cardiac Preload Reserve and Exercise Limitation

Evidence‐Based Strategies and Recommendations for Preservation of Central Venous Access in Children

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