IVUS

Cece · Post by **Cece** » Thu Nov 18, 2010 9:21 am

I ran across this in EVT and found it interesting:

IVUS is a promising technique for the evaluation of venous stenoses that is superior to single-plane venography. It allows the detection of lesion morphology and degree of stenosis (Figure 3). Neglen et al compared the use of IVUS to venography for the evaluation of patients with venous outflow obstruction. In this study, they found that venography underestimated stenosis by 30%. In addition, they reported that venography was considered normal in one-fourth of limbs despite the fact that IVUS showed more than 50% of obstruction. IVUS shows intraluminal details, trabeculations, and webs that may be hidden by the contrast dye. Other advantages of IVUS are its ability to demonstrate external compression directly, wall thickness, and neointimal hyperplasia. To date, IVUS seems to be the best available method for diagnosing clinically significant chronic iliac vein obstruction. http://bmctoday.net/evtoday/2009/07/art ... 709_06.php

When it compares IVUS to venography, I assumed it means catheter venography. If so, the percentages here (30% underestimation of stenosis if IVUS isn't used, 25% of limbs seen as normal with regular venography have obstruction when seen with IVUS) are impressive.

This is a tool we want in our IR's toolboxes. It is also an expensive tool that adds time to the procedure. It also takes some expertise to use correctly.

I bolded the part that fits with what Dr. Zamboni recently said:

cheerleader wrote:
"CCSVI is composed of several blockages in the main outflow routes, the jugular vein, azygous vein, but this is very important to understand," he said, displaying angiographic and high-resolution B-mode images along with a specimen, these blockages "are merely intraluminal defects; not problems in the wall, but intraluminal defects: webs, membranes, malformed valves."

newveins · Post by **newveins** » Thu Nov 18, 2010 9:30 am

If you have the procedure in a hospital as opposed to most clinics they have IVUS available, they used it on me and I could follow along on the screen, but I doubt the clinics will go to the expense unless they know CCSVI treatment is here to stay.

CCSVIhusband · Post by **CCSVIhusband** » Thu Nov 18, 2010 9:33 am

Fantastic find as always Cece ...

MS_HOPE · Post by **MS_HOPE** » Thu Nov 18, 2010 9:35 am

Thanks for this find, Cece. I'm often left wondering, when mention is made of venograms or venography, how we are to know whether reference is being made to MRVs (Magnetic Resonance Venograms, I thought), or catheter venograms. In MSers' posts throughout this forum, people often speak of venograms, and I'm never sure which type they're speaking of. (On a separate note, they refer to going to Albany, and I don't know if it's Dr. Siskin's or Dr. Mehta's group they're talking about. A little frustrating.)

You assume this article is referring to catheter venograms. May I ask why?

Any light you can shed on this would be most helpful -- as you always are!

Thank you!

MS_HOPE

PS I agree that the IVUS sounds like an important tool in diagnosing and treating CCSVI!

Cece · Post by **Cece** » Thu Nov 18, 2010 9:49 am

MS_HOPE wrote:You assume this article is referring to catheter venograms. May I ask why?

I originally had that as a question, then decided I felt reasonably confident enough to put it as an assumption. It talked about it as "transfemoral venography" and many of the patients were stented.

Here's the original research link:
http://www.ncbi.nlm.nih.gov/pubmed/14603188

It's to do with lower body venous outflow obstruction, such as May Thurner syndrome. These researchers, Drs. Neglen and Raju, are the experts in that field.

newveins, good point about hospital vs clinic having it.

MS_HOPE · Post by **MS_HOPE** » Thu Nov 18, 2010 10:38 am

Thanks, Cece. Sounds like a reasonable assumption.

Cece · Post by **Cece** » Thu Nov 18, 2010 8:56 pm

It was only after your question that I looked at the original research, I actually made the assumption based on less information....

newveins, I'm curious, do you think the IVUS made any difference in your case?

drsclafani · Post by **drsclafani** » Thu Nov 18, 2010 9:12 pm

newveins wrote:If you have the procedure in a hospital as opposed to most clinics they have IVUS available, they used it on me and I could follow along on the screen, but I doubt the clinics will go to the expense unless they know CCSVI treatment is here to stay.

IVUS cost is twofold,
there is a machine that costs >$100,000
there is a per unit disposable ultrasound catheter >$500-600 each.

I have used two different IVUS manufacturers that I have used. On one I saw many interesting findings. On the other I could see nothing. They each use different technologies. Thus this is not as simple as IVUS.

ALso I never saw a web. Perhaps I did not have enough experience. I saw many things, but not webs.

So having the unit is not the same as knowing how to use the unit that offers the best tool

it never is easy when it comes to MS, is it?

Cece · Post by **Cece** » Fri Nov 19, 2010 8:45 am

drsclafani wrote:I have used two different IVUS manufacturers that I have used. On one I saw many interesting findings. On the other I could see nothing. They each use different technologies. Thus this is not as simple as IVUS.

Was the other IVUS a cheaper version in some way? How different could the technology be. Thank you for sharing, but that's not good news, I am a fan of IVUS.

ALso I never saw a web. Perhaps I did not have enough experience. I saw many things, but not webs.

If Dr Neglen and Raju are seeing webs using IVUS when looking at the iliac in May Thurner syndrome, do they mean the same thing by web as what we mean by an azygous web or (quite different) a jugular web or neither?

I will pull up more of their research. Dr. Raju's technician posted here last January, he had taken an interest in CCSVI back then, he could be a contender with his skillset.

it never is easy when it comes to MS, is it?

gotta agree with that. But worth the effort.