Upload
vein-global
View
315
Download
4
Tags:
Embed Size (px)
DESCRIPTION
By: Seshadri Raju, MD, FACS Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Citation preview
Pitfalls of IVUS Imaging
SESHADRI RAJU MD.FACSRANE CENTERJACKSON. MS.
Disclosure
Stock in Veniti, Inc.US Patent: IVUS use in venous diseaseVenous stenting is currently off label
GOT TO HAVE IVUS FOR STENT PRACTICE Diagnostic sensitivity of ≈85%
• Sensitivity of transfemoral venography is ≈50% to identify iliac vein lesions (Negus et al; Raju et al).
• Sensitivity of standard ascending venography worse.• Primary &Postthrombotic lesions are missed.• Venography not sensitive enough to pick up anomalies
in stent inflow/outflow and in the stent stack itself. Ie. to guide stent procedure.
• No radiation exposure• Can stent with fluroscopy and IVUS alone in renal
patients and those with contrast allergy
With IVUS, stentable obstructions are found in >90% of primary cases with advanced CVI
Non-thrombotic iliac vein lesion (NIVL)
Normal venogram but IVUS stenosis (PTS). Note trabaculae and perivenous fibrosis on IVUS but
not seen on venogram. IVUS area 72 sq mm.
Same case after stenting. Area now 164 sq mm.In adults CIV should measure ≥ 175 sq mm
Normal Lumen Size
• CIV: 16 mm Diameter; 200 sq mm Area• EIV: 14 mm Diameter; 150 sq mm Area• CFV: 12 mm Diameter; 125 sq mm AreaThe basis of symptoms in CVD is elevation of peripheral venous pressure.Peripheral venous pressure begins to rise with as little as 20% stenosis and becomes significant at 50% stenosis.
“Normal Venogram” with Residual Thrombus on IVUS after PMT
Venographic Sensitivity for complete clot lysis(PMT and CDT) n = 110 venograms
93/110 (85%) “Venographic Success” had residual thrombus on IVUS
Sensitivity of Venography for Complete Lysis = 20%
CLASSIC ROKITANSKI STENOSISDue to perivenous fibrosis
CIV 7mm
11mm
MRV: Unlike venography measurements are possible provided the radiologist gives measurements
Stent CompressionVenogram normal; IVUS shows compression
Missing BorderAt hypogastric orifice
CONCLUSIONSIVUS is “King” in the Endosuite
• With IVUS, you simply see more ‘stuff’ than is ever possible with venography. This will make a difference in improving outcome in cases at the margin.
• Lack of radiation and contrast hazards allow repeated use.
• IVUS is semi-quantitative, venography is not. Makes a difference in diffuse lesions and focal lesions that are borderline.
END
IVUS-MTS.MPG
Postthrombotic focal stenosisNote perivenous fibrosis and normal venogram
Balloon ‘Sizing’Proximal and distal NIVL
IVUS IN PRIMARY STENOSIS WITH WEB
IVUSTips and Tricks
Seshadri Raju MD.FACS.The Rane Center
Flowood, MS
TrabeculumCannot see in venograms
NIVL (MTS)
Malpositioning the stent behind the iliac artery.
• This was a 10 mm stent which thrombosed.