Taimur Saleem1, Seshadri Raju2. 1. RANE Center for Venous and Lymphatic Diseases, Jackson, Miss. Electronic address: taimur@gmail.com. 2. RANE Center for Venous and Lymphatic Diseases, Jackson, Miss.
Abstract
BACKGROUND: Techniques to diagnose and treat chronic iliofemoral venous obstruction (CIVO) have continued to evolve. Intravascular ultrasound (IVUS) displays real-time cross-sectional venous anatomy and can be used to guide venous interventions. However, being invasive, it is not a suitable initial screening tool. The comparison of IVUS with other three-dimensional contrast imaging modalities is less well documented. We have provided a systematic analysis of the performance of IVUS and other three-dimensional contrast imaging modalities for the evaluation of CIVO. METHODS: A search of various databases, including MEDLINE, Embase, EBSCOhost, Cochrane Library, CINAHL PLUS, and Web of Science, was conducted to identify studies that had compared IVUS and at least one other multidimensional contrast imaging modality, including multiplanar venography, computed tomography venography (CTV), computed tomography angiography, or magnetic resonance venography in the evaluation of CIVO. RESULTS: A total of 2117 articles were screened. Of these, eight met the inclusion criteria. Additionally, 12 other studies were identified that had compared IVUS and single plane venography. A meaningful meta-analysis could not be conducted owing to data heterogeneity. The quality of evidence varied from very low to low. IVUS identified stenotic lesions in 0% to 30% more patients compared with multiplanar venography. The CTV and IVUS measurements correlated well with each other. The sensitivity of the two-segment CTV technique approached 97%. The specificity of CTV was 57% to 86% and varied with the venous segment. The sensitivity and specificity of magnetic resonance venography compared with IVUS was 100% and 22.7%, respectively. CONCLUSIONS: Given that IVUS is considered the reference standard used to guide venous interventions in patients with CIVO, the use of venography, despite using multiple projection views, underestimates the severity and presence of venous stenosis and should not be used as the only diagnostic modality. Three-dimensional CTV is noninvasive with a high sensitivity. It can be used to screen patients who might benefit from a more invasive investigation with IVUS. CTV can also be considered for the preoperative planning of venous interventions in patients with CIVO.
BACKGROUND: Techniques to diagnose and treat chronic iliofemoral venous obstruction (CIVO) have continued to evolve. Intravascular ultrasound (IVUS) displays real-time cross-sectional venous anatomy and can be used to guide venous interventions. However, being invasive, it is not a suitable initial screening tool. The comparison of IVUS with other three-dimensional contrast imaging modalities is less well documented. We have provided a systematic analysis of the performance of IVUS and other three-dimensional contrast imaging modalities for the evaluation of CIVO. METHODS: A search of various databases, including MEDLINE, Embase, EBSCOhost, Cochrane Library, CINAHL PLUS, and Web of Science, was conducted to identify studies that had compared IVUS and at least one other multidimensional contrast imaging modality, including multiplanar venography, computed tomography venography (CTV), computed tomography angiography, or magnetic resonance venography in the evaluation of CIVO. RESULTS: A total of 2117 articles were screened. Of these, eight met the inclusion criteria. Additionally, 12 other studies were identified that had compared IVUS and single plane venography. A meaningful meta-analysis could not be conducted owing to data heterogeneity. The quality of evidence varied from very low to low. IVUS identified stenotic lesions in 0% to 30% more patients compared with multiplanar venography. The CTV and IVUS measurements correlated well with each other. The sensitivity of the two-segment CTV technique approached 97%. The specificity of CTV was 57% to 86% and varied with the venous segment. The sensitivity and specificity of magnetic resonance venography compared with IVUS was 100% and 22.7%, respectively. CONCLUSIONS: Given that IVUS is considered the reference standard used to guide venous interventions in patients with CIVO, the use of venography, despite using multiple projection views, underestimates the severity and presence of venous stenosis and should not be used as the only diagnostic modality. Three-dimensional CTV is noninvasive with a high sensitivity. It can be used to screen patients who might benefit from a more invasive investigation with IVUS. CTV can also be considered for the preoperative planning of venous interventions in patients with CIVO.