Issues seen with IVUS not visible to fluoroscopy?

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Issues seen with IVUS not visible to fluoroscopy?

Postby CureOrBust » Fri Jul 01, 2011 8:46 pm

I have been away for a while, so have not kept up to date with all the posts on DR S's thread, so I probably missed it. I do think it deservers its own thread as well.

I have spoken to doctors here in Australia regarding IVUS, and they aren't "sold" on it's benefits over existing fluoroscopy. Has anyone got IVUS images that show a definitive issue requiring treatment, that could not be seen / detected using fluoroscopy (from all angles)?
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Postby Cece » Fri Jul 01, 2011 8:52 pm

Check out this case of Dr. Sclafani's:
www.thisisms.com/ftopicp-162064.html#162064

And this one from Dr. Cumming:
www.thisisms.com/ftopicp-163914.html#163914

here's another one from Dr. Sclafani. It's a long one, you can skim down to the azgyous section because that's the one with a stenosis seen on IUVS, not seen on flouroscopy:
www.thisisms.com/ftopicp-166678.html#166678

Too bad the Australian docs can't make it halfway across the world to the July 15 - 16th Manhattan symposium. I am pretty sure IVUS will be covered.
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Re: Issues seen with IVUS not visible to fluoroscopy?

Postby drsclafani » Fri Jul 01, 2011 11:25 pm

CureOrBust wrote:I have been away for a while, so have not kept up to date with all the posts on DR S's thread, so I probably missed it. I do think it deservers its own thread as well.

I have spoken to doctors here in Australia regarding IVUS, and they aren't "sold" on it's benefits over existing fluoroscopy. Has anyone got IVUS images that show a definitive issue requiring treatment, that could not be seen / detected using fluoroscopy (from all angles)?

cureorbust, it is not just seeing things with IVUS that you cannot see with venography. it is actually about seeing what the pathology really is. Also ivus allows precision not possible with venography for balloon selection, for assessing results of angioplasty, for detection dissections, for identifying that the pathology we are treating is actually NOT a venous stenosis, but rather a valvular stenosis.

I think most would agree that IVUS is superior to venography for valvular disease.
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Postby drsclafani » Fri Jul 01, 2011 11:25 pm

Cece wrote:Check out this case of Dr. Sclafani's:
www.thisisms.com/ftopicp-162064.html#162064

And this one from Dr. Cumming:
www.thisisms.com/ftopicp-163914.html#163914

here's another one from Dr. Sclafani. It's a long one, you can skim down to the azgyous section because that's the one with a stenosis seen on IUVS, not seen on flouroscopy:
www.thisisms.com/ftopicp-166678.html#166678

Too bad the Australian docs can't make it halfway across the world to the July 15 - 16th Manhattan symposium. I am pretty sure IVUS will be covered.


i am going talk about IVUS on patient day and during doctor symposium
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Re: IVUS

Postby NHE » Sat Jul 02, 2011 2:09 am

Not too long ago, Cece posted some info about a book called IVUS Made Easy. I ordered it through my local county library's interlibrary loan (ILL) program. I've read through the first 4 chapters so far. While the title of the book should not be confused with "Zen and the Art of Volkswagen Maintenance" in that it will not turn you into a shade tree IR, the book is helping me to make some sense out of the images that Dr. Sclafani and Dr. Cumming post to the various threads here. I should note that the book is written by doctors for doctors and a medical dictionary is often helpful when reading it as there is no glossary. The book also primarily covers the use of IVUS in arteries and the IVUS images are different due to the different structure of arteries vs. veins. Still, it's proving to be an interesting book to read and the IVUS images are starting to look less like random swirls of dots and more like swirls of dots that have meaning. :wink:


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open minded

Postby hwebb » Sat Jul 02, 2011 4:21 am

I reckon our Aussie IRs are pretty open-minded, and will look at the facts when either this info is published, or they see for themselves (perhaps during a visit to one of the day centres using this technique). My v.good aussie doctor has definitely evolved his technique as more info has come to light, and he's compared experiences with other IR's.
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Re: Issues seen with IVUS not visible to fluoroscopy?

Postby DrCumming » Sat Jul 02, 2011 5:34 am

drsclafani wrote:
CureOrBust wrote:I have been away for a while, so have not kept up to date with all the posts on DR S's thread, so I probably missed it. I do think it deservers its own thread as well.

I have spoken to doctors here in Australia regarding IVUS, and they aren't "sold" on it's benefits over existing fluoroscopy. Has anyone got IVUS images that show a definitive issue requiring treatment, that could not be seen / detected using fluoroscopy (from all angles)?

cureorbust, it is not just seeing things with IVUS that you cannot see with venography. it is actually about seeing what the pathology really is. Also ivus allows precision not possible with venography for balloon selection, for assessing results of angioplasty, for detection dissections, for identifying that the pathology we are treating is actually NOT a venous stenosis, but rather a valvular stenosis.

I think most would agree that IVUS is superior to venography for valvular disease.


I couldn't agree more. At Sal's suggestion I started using IVUS and its completely altered my understanding and approach to treating patients. I would not do these procedures without it.
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Re: Issues seen with IVUS not visible to fluoroscopy?

Postby CureOrBust » Mon Jul 04, 2011 6:35 am

drsclafani wrote:I think most would agree that IVUS is superior to venography for valvular disease.
FYI. The diagnostic vascular doc that referred me for my first treatment (ie he does not perform these, but is a supporter of the treatment), when I asked him less than 6 months ago if they were performing any treatments with IVUS, he looked at me puzzled, and asked me what "IVUS" was...

I original was speaking with a vascular surgeon (that I got you in touch with, as you knew each other, and he performed my second treatment) and he knew what it was and was happy to use it on me (if I covered the cost of the single-use catheter), but was far from convinced of its merits. External constraints meant it was not an option for me. :(
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Re: IVUS

Postby PointsNorth » Mon Jul 04, 2011 8:52 am

NHE wrote:Not too long ago, Cece posted some info about a book called IVUS Made Easy. I ordered it through my local county library's interlibrary loan (ILL) program. I've read through the first 4 chapters so far. While the title of the book should not be confused with "Zen and the Art of Volkswagen Maintenance" in that it will not turn you into a shade tree IR, the book is helping me to make some sense out of the images that Dr. Sclafani and Dr. Cumming post to the various threads here. I should note that the book is written by doctors for doctors and a medical dictionary is often helpful when reading it as there is no glossary. The book also primarily covers the use of IVUS in arteries and the IVUS images are different due to the different structure of arteries vs. veins. Still, it's proving to be an interesting book to read and the IVUS images are starting to look less like random swirls of dots and more like swirls of dots that have meaning. :wink:


NHE


I'm finding IVUS Made Easy a bit dense. I hear IVUS for Dummies will be out next month. 8)
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Postby Cece » Mon Jul 04, 2011 9:06 am

The "Complete Idiot's Guide to IVUS," too.

NHE, I'm impressed you tracked down the book! I remember being amused by the title, that's why I noticed it in the first place.
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Postby PointsNorth » Mon Jul 04, 2011 1:36 pm

Voila. It came early.

Image
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Postby Cece » Mon Jul 04, 2011 2:48 pm

:lol: :lol: that was good for a laugh! Someone send a copy to Dr. Nero Ologist!
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Postby PointsNorth » Mon Jul 04, 2011 4:05 pm

I thought Dr. S could use on the first slide of his IVUS presentation at the Symposium.
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Re: IVUS

Postby NHE » Mon Jul 04, 2011 4:15 pm

Cece wrote:NHE, I'm impressed you tracked down the book! I remember being amused by the title, that's why I noticed it in the first place.


My library tracked down the book. They deserve the credit. It came from a library 2270 miles away.

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