Comparison of computed tomography venography and intravascular ultrasound in screening and classification of iliac vein obstruction in patients with chronic venous disease

To investigate power of computed tomography venography (CTV) to identify and characterize iliac vein obstruction (IVO) compared with intravascular ultrasound (IVUS) examination in highly symptomatic patients with chronic venous disease (CVD). CVD CEAP C3-6 limbs with visual analog scale for pain sco...

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Published in:	Journal of vascular surgery. Venous and lymphatic disorders (New York, NY) Vol. 8; no. 3; pp. 413 - 422
Main Authors:	Rossi, Fabio H., Kambara, Antônio M., Rodrigues, Thiago O., Rossi, Cybelle B.O., Izukawa, Nilo M., Pinto, Ibraim M.F., Thorpe, Patricia E.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-05-2020
Subjects:	Adult Aged Chronic Disease Classification Cockett syndrome Computed Tomography Angiography Computed tomography Venography Constriction, Pathologic Female Humans Iliac Vein - diagnostic imaging Iliac vein obstruction Intravascular ultrasound Male May-Thuner syndrome Middle Aged Multidetector Computed Tomography Phlebography Predictive Value of Tests Prospective Studies Severity of Illness Index Ultrasonography, Interventional Vascular Diseases - diagnostic imaging May-Thuner syndrome Cockett syndrome Intravascular ultrasound Iliac vein obstruction Computed tomography Venography Classification
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Summary:	To investigate power of computed tomography venography (CTV) to identify and characterize iliac vein obstruction (IVO) compared with intravascular ultrasound (IVUS) examination in highly symptomatic patients with chronic venous disease (CVD). CVD CEAP C3-6 limbs with visual analog scale for pain score of greater than 3 and/or Venous Clinical Severity Scale of greater than 8 were prospectively investigated with CTV and IVUS examination. The segment of maximum IVO was verified and categorically classified: group I, 0% to 49%; group II, 50% to 79%; and group III, 80% or greater. The CTV's screening power to detect the point and degree of maximum IVO was compared with IVUS. The CTV point of maximum IVO was 80% in the left limb, 10% in the right limb, 10% bilaterally; 2% in the inferior vena cava; 91% in the common iliac vein (CIV) confluence (41.6% below the CIV confluence, 34.5 at the CIV confluence, and 23.9% above the CIV confluence); 7% at the external iliac vein (kappa index 0.841; P < .001, when compared with IVUS). The distal venous segment considered free of obstruction was above inguinal ligament: 68% (CIV, 47%; external iliac vein, 21%) 32% below the inguinal ligament (common femoral vein, 26%; deep femoral vein, 6%) (kappa index 0.671; P = .023, when compared with IVUS). The power of CTV to detect an IVO of 50% or greater (groups II and III) when compared with IVUS achieved a sensitivity and specificity ratio of 94.0% and 79.2%, respectively. The positive predictive value was 94%, the negative predictive value was 79.1%, accuracy was 86.7% (kappa, 0.733), and interobserver agreement was 92.1% (95% confidence interval, 87.1-97.7; kappa, 0.899). CTV is a powerful screening method in determining the precise point of compression and classifying IVO in limbs with symptomatic CVD when compared with IVUS. The prevalence of an obstruction above the iliac vein confluence is significant and should be considered in iliac vein stenting treatment strategy. The tomographic classification system proposed here may help to define the optimum technique of treatment, prognosis, and comparison of outcome results. [Display omitted]
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2213-333X 2213-3348
DOI:	10.1016/j.jvsv.2019.09.015