The Use of Intravascular Ultrasound During Deep Venous Interventions in a Tertiary Care Center

Abstract

Objective

Intravascular ultrasound (IVUS) is the gold standard for diagnosing venous stenosis and sizing venous stents, yet its impact on thrombosis after deep venous interventions is not well-studied. This study evaluates the impact of IVUS on outcomes of lower extremity deep venous interventions, hypothesizing improved results with its use.

Methods

This retrospective study analyzed consecutive patients undergoing deep venous lower extremity interventions, dividing them into two groups based on IVUS use. Patient characteristics and outcomes, including primary patency and symptomatic improvement, were compared.

Results

Among 185 patients (75.7% with IVUS), those without IVUS had higher rates of COPD (16% vs 5%; P = 0.045), chronic kidney disease (27% vs 5%; P < 0.001), and hypercoagulable state (47% vs 19%; P = 0.001). Non-IVUS patients more frequently presented with thrombotic disease (78% vs 40%; P < 0.001), while IVUS patients were more likely to have edema (41% vs 31%; P = 0.04) and receive stenting (92% vs 44%; P < 0.001). Wallstent was the most commonly used stent in both groups. IVUS patients achieved higher technical success (99% vs 82%; P < 0.001) and had fewer 30-day complications (7% vs 20%; P = 0.022). Over a mean follow-up of 3.5 years, IVUS use was associated with greater symptom relief (50% vs 41%; P < 0.001) and higher primary patency rates (83% vs 53%; P < 0.001). Regression analysis showed that age, prior anticoagulant use, and thrombolysis were significantly associated with loss of patency, while IVUS showed a trend toward decreased loss of patency (HR = 0.6; P = 0.244).

Conclusion

IVUS use during deep venous interventions is associated with fewer complications and improved primary patency rates, suggesting its utility in enhancing patient outcomes when complementing multiplanar venography.