Jang Yong Kim
Nationality
Korea
Current Position
Professor
Organization
Division of Vascular and Transplant Surgery, Department of Surgery College of Medicine, The Catholic University of Korea
Medication Forum Session

Topic: IVUS guided venous stenting

Abstract

Venous stenting for symptomatic venous obstruction is becoming popular especially in iliac venous lesion. Multiplanar venography has been used for diagnosis of iliac vein occlusion, which is limited by Rokitansky stenosis from compression of right iliac artery. Conventional stents for venous disease were originally designed for arterial disease so their usage is limited because of complication following venous stenting with conventional stents. So, optimal iliac vein stenting needs accurate diagnosis of lesion, which can evaluate venous narrow lesion and its compressing artery together and venous dedicated stent. Intravascular ultrasound (IVUS) uses a tiny ultrasound transducer mounted on the tip of a catheter to image the interior of blood vessels. IVUS can be used to assess vessel/lumen diameter, lesion length, help determine the amount of plaque buildup in a vessel and its composition and check to ensure stents have been properly placed and fully deployed. It can also help measure the effectiveness of balloon angioplasty or stenting during follow ups. IVUS can be used small sized blood vessel (0.014 based catheter), medium sized blood vessel (0.018 based catheter) and large sized blood vessel (0.035 based catheter). Initially, IVUS has been used from coronary artery with excellent results. 0.035 based IVUS catheter can see blood vessel up to 60mm, which can see aorta and inferior vena cava. IVUS can be used for lesion evaluation, decision making for treatment and evaluation of treatment resultsVenous stenting for symptomatic venous obstruction is becoming popular especially in iliac venous lesion. Multiplanar venography has been used for diagnosis of iliac vein occlusion, which is limited by Rokitansky stenosis from compression of right iliac artery. Conventional stents for venous disease were originally designed for arterial disease so their usage is limited because of complication following venous stenting with conventional stents. So, optimal iliac vein stenting needs accurate diagnosis of lesion, which can evaluate venous narrow lesion and its compressing artery together and venous dedicated stent. Intravascular ultrasound (IVUS) uses a tiny ultrasound transducer mounted on the tip of a catheter to image the interior of blood vessels. IVUS can be used to assess vessel/lumen diameter, lesion length, help determine the amount of plaque buildup in a vessel and its composition and check to ensure stents have been properly placed and fully deployed. It can also help measure the effectiveness of balloon angioplasty or stenting during follow ups. IVUS can be used small sized blood vessel (0.014 based catheter), medium sized blood vessel (0.018 based catheter) and large sized blood vessel (0.035 based catheter). Initially, IVUS has been used from coronary artery with excellent results. 0.035 based IVUS catheter can see blood vessel up to 60mm, which can see aorta and inferior vena cava. IVUS can be used for lesion evaluation, decision making for treatment and evaluation of treatment results1. Lesion evaluation: the true vessel size, presence of calcium and thrombus, true lesion length, the physiologic importance of a lesion, any compressing lesion 2. Decision making of treatment: stent size, stent length, location of stent deployment3. Evaluation of treatment results: stent expansion, apposition, residual narrowing post-PTA injuryVIDIO trial is Prospective multicenter single arm study and compared Multiplanar venography and IVUS for iliofemoral vein obstruction. IVUS detected more significant lesions than Multiplanar venography and changed 57% of venous treatment plan after IVUS evaluation. IVUS guided venous stenting can be used with excellent results. 

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