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Intravascular Ultrasound for Venous Stenting and Inferior Vena Cava Filter Insertion

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Noninvasive Vascular Diagnosis

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Abstract

Presently venous intravascular ultrasound (IVUS) is mainly used to diagnose venous stenosis, to guide stenting of venous obstruction, and to assist in placement of IVC filters. IVUS visualizes the vessel from inside the lumen outward and penetrates the adjacent structures. It gives the full 360° view of the crosscut vessel lumen, the character of the luminal wall, and possible external compression. For appropriate coverage of the entire lumen in the ilio-caval system, an ultrasound frequency of ∼12.5 MHz or lower is necessary. The disposable IVUS catheter rides usually coaxially on a guidewire placed in the vein percutaneously. After advancing the IVUS catheter to a level above the area of interest, images are obtained during catheter withdrawal through the lumen and digitally stored.

The diagnosis of ilio-caval outflow obstruction must ultimately be made by morphological investigations, preferably IVUS. The use of IVUS in these patients has the dual purpose of accurately diagnosing the degree, extent, and nature of obstruction and aiding in appropriate placement of the stent. Stenting can be performed without venography, using only IVUS in combination with fluoroscopy.

There has also been a transition from placement of IVC filters in the interventional suite under fluoroscopy with venography to an IVUS-guided bedside deployment. The use of IVUS is obviously beneficial in patients with contraindications to iodinated contrast dye or limitations of radiation exposure. It also decreases the radiation exposure for the interventionalist. Morbidly obese patients may exceed the weight limits of the angiographic table. Prophylactic IVC filters are increasingly placed in critically ill and multiple trauma patients. To transport these ICU patients to an interventional suite is cumbersome.

The cost of the technology has hampered widespread use, but it can be expected that the costs for the equipment will decrease with increased utilization.

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Authors and Affiliations

  1. Department of Vascular Surgery, SP Vascular Center, 3 Parthenonos Street, 4730, Trimiklini, Limassol, Cyprus

    Peter Neglén M.D., Ph.D.

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  1. Peter Neglén M.D., Ph.D.
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Correspondence to Peter Neglén M.D., Ph.D. .

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Editors and Affiliations

  1. Robert C. Byrd Health Sciences Center, Dept. Surgery, West Virginia University, MacCorkle Ave. SE 3100, Charleston, 25304, West Virginia, USA

    Ali F. AbuRahma

  2. , Interventional Cardiology, UC San Diego Sulpizio Cardiovascular Cen, 9300 Campus Point Drive 7784, La Jolla, 92037, California, USA

    Dennis F. Bandyk

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Neglén, P. (2013). Intravascular Ultrasound for Venous Stenting and Inferior Vena Cava Filter Insertion. In: AbuRahma, A., Bandyk, D. (eds) Noninvasive Vascular Diagnosis. Springer, London. https://doi.org/10.1007/978-1-4471-4005-4_43

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  • DOI: https://doi.org/10.1007/978-1-4471-4005-4_43

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  • Online ISBN: 978-1-4471-4005-4

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