drsclafani wrote:this is still a work in progress, and i have not vetted this by anyone yet, but IVUS is informative to me.
This image shows IVUS interrogating three areas of the right jugular vein (IVUS images on the left corresponding to the normal areas of the vein (red arrows). In the J1 segment, one notes on venography a narrowing. The ivus shows the valve edges as bright signals (yellow curved arrows). One can see that the valve is the problem.
It is not that it is opening normally; on the contrary, it is failing to open normally and has created a funnel that restricts flow into the inominate vein.
The goal of treatment is not to stretch a normal annulus, but to tear the annulus and disrupt the funnel effect.
In this case i used high pressure large 18 mm balloons to disrupt the annulus and to tear the funnel apart. As you can see from the post procedure image, flow is excellent and the diameter is now normal
We really haven't discussed this yet. With the third IVUS image, were the valve leaflets fixed and always as they are in the image or was there some small movement? If it were a healthy valve, how would it look different, would there still be bright signals showing the valve edge?
If you were looking at it with the IVUS that didn't work for this, how would it look different? Would the valve not be as easily seen? How can two IVUSes differ like that!
In the first of the three IVUS images, it's corresponding to an area on the venogram that looks suspicious, with the darker contrast above the light area. Could this be misinterpreted as a stenosis in need of treating? You can really see how both of the first two IVUS images look so similar but so different on the venogram.
The post-venography images are always the beauty shots, it is wonderful seeing all the various tortuosities turned into straightforward flow.