IVUS for Arterial and Venous Disease

[Michael Barraza]
Mike, what all are you using IVUS for, either on the venous or arterial side?

[Michael Cumming]
I use IVUS pretty much routinely. In the majority of my PAD new cases I'll use IVUS. Obviously for iliac vein compression, pelvic venous congestion … those are great cases for IVUS. I hate not using IVUS. I think it gives us great delineation, it gives us very accurate measurements, and it saves on fluoro time.

[Michael Barraza]
Okay. Mark, what about you?

[Mark Lessne]
Yeah, so I'll use IVUS for all my venous interventions, especially chronic venous interventions within the acute setting. If I'm not doing single session, I’ll usually defer IVUS until I'm done and ready to finish up the job. But I'll tell you, Mike made some really important points that I want to make sure we don't gloss over them. He talks about how we use IVUS and how we think about that in terms of looking for 50% narrowing in iliac veins, and we're looking for cross sectional area. And all of these things are somewhat arbitrarily defined by our gut, and our expertise for whatever that means. There's a big trial, the VIDIO trial, which showed that IVUS changes clinical management in a good percentage of patients.

The problem is, and this is the point that Mike made that can't be understated, we never show that it changes clinical management for the better. So there's no study that shows, "Oh, when I use IVUS, the Villalta score decreases, quality of life increases." All we know is that when I use IVUS, I angioplasty it and stent it whereas before I wouldn't have, but we really don't know. So I think getting familiar with IVUS is important, but I think we have to know its limitations. So you asked me where I use it, I use it as a complementary tool in almost all my chronic venous cases, but along with flow dynamics of venography.

[Michael Barraza]
Mark, are you using IVUS for your central venous cases as well?

[Mark Lessne]
Yeah, it's a good question. So I would say I have a very large thoracic venous obstructive practice and I will use it for areas of questionable concern. So in other words, a patient comes with arm swelling and they've gotten nothing on venography, I've used it for them to identify webs that can be subtle. The other thing is there is a compressive syndrome in the chest called left brachiocephalic or innominate compression. It’s where the vein gets compressed between the sternum and the aorta and IVUS can be helpful there. So I will use it then. It's certainly not performed as routinely as in the lower extremity and pelvis. But you can use it for problem solving in the thoracic veins as well.