Abstract Background: While several trials have established the superiority of intravascular ultrasound (IVUS) over traditional venography in cardiac interventions, evidence supporting its role in peripheral venous disease remains limited, particularly within the Indian population. This study aimed to evaluate the evolving role of IVUS in the assessment and management of nonthrombotic iliac venous obstruction in an Indian population. Materials and Methods: A prospective, investigator-initiated, single-center study was conducted at a tertiary-care center in Maharashtra, India, from February 2022 to May 2022. Symptomatic patients with a normal digital subtraction angiography venogram with deep venous refluxes and ineligible for endovenous ablation treatments were consecutively enrolled. Patients with CEAP C4–C6 disease demonstrating iliac vein narrowing and/or deep venous reflux on Valsalva on duplex ultrasound, suggestive of iliac venous outflow obstruction, were included. All patients underwent both venography and IVUS, and imaging findings were compared. Results: A total of 20 patients were studied. Minimal vessel diameter (venography: 7.04 ± 2.52 mm vs. IVUS: 2.90 ± 1.90 mm, P < 0.001) and reference vessel diameter (venography: 11.22 ± 2.89 mm vs. IVUS: 9.80 ± 2.59 mm, P < 0.001) were significantly higher on venography. Minimal vessel area and reference vessel area were also statistically higher on venography. In contrast, diameter stenosis (venography: 40.80% ±16.70% and IVUS: 71.21% ±15.96%, P < 0.001) and area stenosis (venography: 53.14% ±19.50% and IVUS: 66.37% ±11.09%) were lower on IVUS. The sensitivity of venography for correctly diagnosing significant stenosis was approximately 25%. Conclusion: Compared to traditional venography, IVUS is a valuable and effective imaging modality in the diagnosis and treatment of nonthrombotic iliac venous outflow obstructions in the Indian population.
Shah et al. (Wed,) studied this question.