Sahar H Ali, Paula Pinto Rodriguez, Ehsan Abualanain, Ying Li, Mostafa S Khalil, Hesham Aboloyoun, Juan Carlos Perez Lozada, Edouard Aboian, Robert Attaran, Cassius Iyad Ochoa Chaar
{"title":"The Use of Intravascular Ultrasound During Deep Venous Interventions in a Tertiary Care Center.","authors":"Sahar H Ali, Paula Pinto Rodriguez, Ehsan Abualanain, Ying Li, Mostafa S Khalil, Hesham Aboloyoun, Juan Carlos Perez Lozada, Edouard Aboian, Robert Attaran, Cassius Iyad Ochoa Chaar","doi":"10.1177/15385744251326989","DOIUrl":null,"url":null,"abstract":"<p><p>ObjectiveIntravascular 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.MethodsThis 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.ResultsAmong 185 patients (75.7% with IVUS), those without IVUS had higher rates of COPD (16% vs 5%; <i>P</i> = 0.045), chronic kidney disease (27% vs 5%; <i>P</i> < 0.001), and hypercoagulable state (47% vs 19%; <i>P</i> = 0.001). Non-IVUS patients more frequently presented with thrombotic disease (78% vs 40%; <i>P</i> < 0.001), while IVUS patients were more likely to have edema (41% vs 31%; <i>P</i> = 0.04) and receive stenting (92% vs 44%; <i>P</i> < 0.001). Wallstent was the most commonly used stent in both groups. IVUS patients achieved higher technical success (99% vs 82%; <i>P</i> < 0.001) and had fewer 30-day complications (7% vs 20%; <i>P</i> = 0.022). Over a mean follow-up of 3.5 years, IVUS use was associated with greater symptom relief (50% vs 41%; <i>P</i> < 0.001) and higher primary patency rates (83% vs 53%; <i>P</i> < 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; <i>P</i> = 0.244).ConclusionIVUS 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.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744251326989"},"PeriodicalIF":0.0000,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Vascular and endovascular surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/15385744251326989","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
ObjectiveIntravascular 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.MethodsThis 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.ResultsAmong 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).ConclusionIVUS 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.
目的血管内超声(IVUS)是诊断静脉狭窄和确定静脉支架尺寸的金标准,但其对深静脉干预后血栓形成的影响尚不清楚。本研究评估了IVUS对下肢深静脉干预结果的影响,并假设使用IVUS可以改善结果。方法回顾性分析连续接受下肢深静脉介入治疗的患者,根据静脉输液使用情况分为两组。比较患者特征和结果,包括原发性通畅和症状改善。结果185例患者中(75.7%接受静脉注射),未接受静脉注射的患者COPD发生率更高(16% vs 5%;P = 0.045),慢性肾病(27% vs 5%;P < 0.001),高凝状态(47% vs 19%;P = 0.001)。非ivus患者更常出现血栓性疾病(78% vs 40%;P < 0.001),而IVUS患者更容易出现水肿(41% vs 31%;P = 0.04),接受支架植入术(92% vs 44%;P < 0.001)。Wallstent是两组中最常用的支架。IVUS患者获得了更高的技术成功率(99% vs 82%;P < 0.001), 30天并发症较少(7% vs 20%;P = 0.022)。在平均3.5年的随访中,IVUS的使用与更大的症状缓解相关(50% vs 41%;P < 0.001)和更高的原发性通畅率(83% vs 53%;P < 0.001)。回归分析显示,年龄、抗凝血史和溶栓与通畅丧失有显著相关,而IVUS有降低通畅丧失的趋势(HR = 0.6;P = 0.244)。结论在深静脉干预中使用ivus可减少并发症,提高初级通畅率,提示其在补充多平面静脉造影时可提高患者预后。