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Original communication

Computed tomography venography versus intravascular ultrasound in the diagnosis of iliofemoral vein stenosis

Published Online:November 06, 2020https://doi.org/10.1024/0301-1526/a000920

Abstract

Summary:Background: Iliofemoral vein stenosis can cause debilitating chronic venous disease. Diagnostic tools include both computed tomography venography (CTV) and intravascular ultrasonography (IVUS). We aim to compare the diagnostic performance of CTV and IVUS. Patients and methods: We performed a retrospective study of patients with chronic venous disease presenting with iliac vein compression or post-thrombotic limb symptoms, excluding those with acute deep vein thrombosis, high anaesthesia risk, or who had contrast allergy. All patients received CTV before IVUS, as part of the diagnostic work-up and intervention. The cross-sectional area (CSA) of iliofemoral vein segments obtained from both studies were compared against reference CSAs to derive percentage stenosis. A 50% reduction in CSA was considered significant. Results: We studied 50 patients between May 2018 and April 2019. 58% of patients had severe disease CEAP C5-6. 48% of patients had at least one vein segment with significant stenosis. The left proximal common iliac vein was the most commonly stenosed vein segment (n = 12, 24% on IVUS). CSA measurements from CTV were greater than those of IVUS, with a correlation coefficient of 0.57 (p < 0.005). Conversely, percentage stenosis measured on CTV was lower than on IVUS, with approximately one-third of significant stenosis missed on CTV (58 veins from CTV vs. 78 from IVUS, p < 0.005). With IVUS as the gold standard, CTV has low sensitivity (37.2%, 95% CI 26.5–48.9) and high specificity (92.5%, 95% CI 89.3–94.9) in detecting significant stenosis. Conclusions: CTV has limited diagnostic performance in identifying iliofemoral vein stenosis. Patients with normal CTV findings should proceed with IVUS imaging if the clinical features are supportive of iliofemoral vein stenosis.

References

  • 1 Kibbe MR, Ujiki M, Goodwin AL, Eskandari M, Yao J, Matsumura J. Iliac vein compression in an asymptomatic patient population. J Vasc Surg. 2004;39(5):937–43. First citation in articleCrossref Medline, Google Scholar

  • 2 Cockett F, Thomas ML, Negus D. Iliac vein compression – Its relation to iliofemoral thrombosis and the post-thrombotic syndrome. BMJ. 1967;2(5543):14. First citation in articleCrossref Medline, Google Scholar

  • 3 Ezhumalai B, Mathur A. May-Thurner syndrome needs to be ruled out in unexplained left-sided deep venous thrombosis: Three-tiered endovascular therapy is warranted. CVCR. 2018;2(2):73–6. First citation in articleGoogle Scholar

  • 4 Butros SR, Liu R, Oliveira GR, Ganguli S, Kalva S. Venous compression syndromes: clinical features, imaging findings and management. Br J Radiol. 2013;86(1030):20130284. First citation in articleCrossref Medline, Google Scholar

  • 5 Neglen P, Thrasher TL, Raju S. Venous outflow obstruction: An underestimated contributor to chronic venous disease. J Vasc Surg. 2003;38(5):879–85. First citation in articleCrossref Medline, Google Scholar

  • 6 Rossi FH, Kambara AM, Izukawa NM, Rodrigues TO, Rossi CB, Sousa AG, et al. Randomized double-blinded study comparing medical treatment versus iliac vein stenting in chronic venous disease. J Vasc Surg Venous Lymphat Disord. 2018;6(2):183–91. First citation in articleCrossref Medline, Google Scholar

  • 7 Fronek A, Criqui MH, Denenberg J, Langer RD. Common femoral vein dimensions and hemodynamics including Valsalva response as a function of sex, age, and ethnicity in a population study. J Vasc Surg. 2001;33(5):1050–6. First citation in articleCrossref Medline, Google Scholar

  • 8 Sermsathanasawadi N, Pruekprasert K, Pitaksantayothin W, Chinsakchai K, Wongwanit C, Ruangsetakit C, et al. Prevalence, risk factors, and evaluation of iliocaval obstruction in advanced chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord. 2019;7(3):441–7. First citation in articleCrossref Medline, Google Scholar

  • 9 Brazeau NF, Harvey HB, Pinto EG, Deipolyi A, Hesketh RL, Oklu R. May-Thurner syndrome: diagnosis and management. VASA. 2013;42(2):96–105. First citation in articleLink, Google Scholar

  • 10 Marston W, Fish D, Unger J, Keagy B. Incidence of and risk factors for iliocaval venous obstruction in patients with active or healed venous leg ulcers. J Vasc Surg. 2011;53(5):1303–8. First citation in articleCrossref Medline, Google Scholar

  • 11 Rossi FH, Gama CAR, Fonseca IYI, Barros KJF, Rodrigues TO, Pinto IMF, et al. Computed Tomograpy Venography diagnosis of iliocaval venous obstruction in advanced chronic venous insufficiency. J Vasc Bras. 2014;13(4):306–11. First citation in articleCrossref, Google Scholar

  • 12 Rossi FH, Kambara AM, Rodrigues TO, Rossi CB, Izukawa NM, Pinto IM, et al. Comparison of computed tomography venography and intravascular ultrasound in screening and classification of iliac vein obstruction in patients with chronic venous disease. J Vasc Surg Venous Lymphat Disord. 2020;8(3):413–22. First citation in articleCrossref Medline, Google Scholar

  • 13 Oguzkurt L, Özkan U, Tercan F, Koç Z. Ultrasonographic diagnosis of iliac vein compression (May-Thurner) syndrome. Diagn Interv Radiol. 2007;13(3):152. First citation in articleMedline, Google Scholar

  • 14 Oguzkurt L, Tercan F, Pourbagher MA, Kizilkilic O, Turkoz R, Boyvat F. Computed tomography findings in 10 cases of iliac vein compression (May-Thurner) syndrome. Eur J Radiol. 2005;55(3):421–5. First citation in articleCrossref Medline, Google Scholar

  • 15 Chung JW, Yoon CJ, Jung SI, Kim H-C, Lee W, Kim YI, et al. Acute iliofemoral deep vein thrombosis: evaluation of underlying anatomic abnormalities by spiral CT venography. J Vasc Interv Radiol. 2004;15(3):249–56. First citation in articleCrossref Medline, Google Scholar

  • 16 Neglén P, Raju S. Intravascular ultrasound scan evaluation of the obstructed vein. J Vasc Surg. 2002;35(4):694–700. First citation in articleCrossref Medline, Google Scholar

  • 17 Raju S, Walker W, Noel C, Kuykendall R, Jayaraj A. The two-segment caliber method of diagnosing iliac vein stenosis on routine computed tomography with contrast enhancement. J Vasc Surg Venous Lymphat Disord (in press) First citation in articleGoogle Scholar

  • 18 Chamarthy MR, Sutphin P, Anderson M, Reddick M, Kalva SP. Evolving Concepts in the Diagnosis and Management of May-Thurner Syndrome. J Clin Interv Radiol. 2017;1(1):23–30. First citation in articleCrossref, Google Scholar

  • 19 Gagne PJ, Tahara RW, Fastabend CP, Dzieciuchowicz L, Marston W, Vedantham S, et al. Venography versus intravascular ultrasound for diagnosing and treating iliofemoral vein obstruction. J Vasc Surg Venous Lymphat Disord. 2017;5(5):678–87. First citation in articleCrossref Medline, Google Scholar

  • 20 Tang T, Goh R, Damodharan K, Choke E, Chong T, Tan Y. RE: “Long-term follow-up of stenting across the ilio-caval confluence in patients with iliac venous lesions”: the value of using IVUS and a dedicated oblique venous stent for deep vein work involving the ilio-caval bifurcation. J Thromb Thrombolysis. 2019;47(2):328–30. First citation in articleCrossref Medline, Google Scholar

  • 21 McLafferty RB. The role of intravascular ultrasound in venous thromboembolism. Semin Intervent Radiol. 2012;29(1):10–5. First citation in articleCrossref Medline, Google Scholar

  • 22 Marteslo JP, Makary MS, Khabiri H, Flanders V, Dowell JD. Intravascular ultrasound for the peripheral vasculature – current applications and new horizons. Ultrasound Med Biol. 2019;46(2):216–24. First citation in articleCrossref Medline, Google Scholar