Transabdominal duplex ultrasound and intravascular ultrasound planimetry measures of common iliac vein stenosis are significantly correlated in a symptomatic population

Publication Name

Journal of Vascular Surgery: Venous and Lymphatic Disorders


Objective: The objectives of the present study were to determine the validity of transabdominal duplex ultrasound (TAUS) against the reference standard of intravascular ultrasound (IVUS) examinations for the detection of iliac vein obstruction (IVO). Methods: We analyzed the data from patients at a private vascular laboratory who had undergone IVUS investigation with an intention to treat because of symptoms of chronic venous insufficiency and a high suspicion of IVO. These patients had also previously undergone a TAUS examination at the same location. The TAUS and IVUS planimetry measures of the left common iliac vein (CIV) were correlated. These included the TAUS-measured minimum and maximum diameter and the percentage of stenosis with the IVUS-measured minimum and maximum diameter and area and the percentage of stenosis. Results: The TAUS and IVUS data from 47 patients (83% female; age, 49.3 ± 17.3 years; 64% obese) were included in the analyses. We found 89% agreement between the TAUS and IVUS findings regarding the identification of left CIV stenosis of ≥50%. The TAUS data had a positive predictive value of 95.5%. The TAUS measures of the minimum diameter and percentage of stenosis correlated significantly with the IVUS measures of the minimum diameter, minimum area, and cross-sectional area of the percentage of stenosis. The strongest correlations were between the TAUS-measured minimum diameter and IVUS-measured minimum area and percentage of the area of stenosis according to the literature-derived value. The TAUS-measured vein diameter of 8 mm equated to an IVUS cross-sectional area of 94.2 mm (53% stenosis), and an IVUS cross-sectional area of 50% of stenosis equated to a TAUS diameter of 8.56 mm. Conclusions: The findings from the present study support the validity of TAUS evaluation as a workup diagnostic tool for the detection of IVO. Our findings also support the use of TAUS planimetry—in particular, the CIV diameter of ≤8 mm as a threshold value—to indicate clinically relevant stenosis and trigger an IVUS investigation with an intention to treat, because this correlated with a cross-sectional area stenosis of ≥50%, as determined by IVUS examination. 2

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