Venogram Versus Intravascular Ultrasound for Diagnosing and Treating Iliofemoral Vein Obstruction (VIDIO): Report From a Multicenter, Prospective Study of Iliofemoral Vein Interventions

s from the 2016 American Venous Forum Annual Meeting Venogram Versus Intravascular Ultrasound for Diagnosing and Treating Iliofemoral Vein Obstruction (VIDIO): Report From a Multicenter, Prospective Study of Iliofemoral Vein Interventions Table. Significant iliofemoral vein stenosis/obstruction Lesion detection (N 1⁄4 100 patients) IVUS Multiplanar venography No. of lesions detected, total 124 66 No. of patients with: 0 lesions detected 19 48 1 lesion detected 46 40 2 lesions detected 27 10 3 lesions detected 8 2 P. J. Gagne, R. Tahara, C. Fastabend, L. Dzieciuchowicz, W. Marston, S. Vedantham, W. Ting, M. Iafrati, M. Lugli, A. Gasparis, S. Black, P. Thorpe, M. Passman. Norwalk Hospital; Allegheny Vein & Vascular Bradford, Pa; Imperial Health, Lake Charles, La; Szpital Kli niczny Przemienienia Panskiego Uniwersytetu Medycznego w Poznaniu, Poznan, Poland; University of North Carolina, Chapel Hill, NC; Wash ington University, St. Louis, Mo; Mt. Sinai Hospital, New York, NY; Tufts Medical Center, Boston, Mass; Hesperia Hospital Clinic, Modena, Italy; Stony Brook Medicine, Stony Brook, NY; St. Thomas Hospital, London, UK; Arizona Heart, Phoenix, Ariz; University of Alabama, Birmingham, Ala Background: Iliac/common femoral vein obstruction (ICFVO) can cause both severe venous insufficiency and significant patient morbidity. When identified, treatment with percutaneous angioplasty and stent can be life changing. Both multiplanar venography and intravascular ultrasound are used to diagnose ICFVO and to guide intervention. This study was designed to (1) prospectively compare the diagnostic performance of con ventional multiplanar venography vs intravascular ultrasound (IVUS) for diagnosing and treating ICFVO; and (2) to characterize the patient response to iliofemoral vein intervention (ie, clinical improvement, quality of life [QoL]) over 6 months of follow up. Methods: In a prospective, multicenter, single arm study, patients (clinical class CEAP C4 C6) underwent invasive assessment for ICFVO and possible endovascular intervention. In patients with bilateral disease, the more severely affected leg was designated the study limb. Exclusion criteria were prior venous stents, venovenous bypass surgery, known chronic total occlusion; severe superficial venous reflux; acute deep vein thrombosis, history of thrombophilia; and elevated serum creatinine. All patients under went multiplanar (ie, AP, RAO, LAO) venography of the study leg, and a treatment strategy based on the venograms was documented. All patients then underwent IVUS evaluation of the study leg, and the final treatment strategy was documented. Completion multiplanar venography and IVUS was performed after any intervention. Significant ICFVO was (1) 50% diam eter stenosis on venogram, (2) 50% cross sectional area stenosis on IVUS, (3) webs or collaterals. Duplex ultrasound, CEAP class, Venous Clinical Severity Score (VCSS), QoL questionnaires (ie, SF 36v2, CIVIQ 14), and ulcer measurements were performed at baseline, 1 month and 6 month follow up visits. Results: Between July, 2014 and July, 2015, 100 patients were enrolled at 11 U.S. and three European centers. Median age was 63 years (range, 30 85 years); 43% were women; left right study leg distribution was 63:37. Baseline parameters were CEAP: C4 (35%), C5 (15%), C6 (50%); VCSS (scale 0 30) 14.5 6 4.8 (mean 6 SD); CIVIQ 14 (scale 0 100) 54.9 6 23.9 (mean 6 SD). The Table summarizes lesion detection by modality. IVUS detected significantly more lesions than multiplanar venography (P 0.05), * (<0.05), ** (<0.01), *** (<0.001). 136 (P < .0001) in a cohort of patients with advanced venous insufficiency. Data regarding lesion characteristics, stent sizing, treatment plan changes based on venogram vs IVUS, and clinical/QoL response to intervention will be available for report at the end of 2015. Author Disclosures: P. J. Gagne: Speaker/honoraria, grants, consultant/ advisory board, collaborator for Volcano Corporation; R. Tahara: Nothing to disclose; C. Fastabend: Nothing to disclose; L. Dzieciuchowicz: Nothing to disclose; W. Marston: Nothing to disclose; S. Vedantham: Nothing to disclose; W. Ting: Nothing to disclose; M. Iafrati: Nothing to disclose; M. Lugli: Nothing to disclose; A. Gasparis: Nothing to disclose; S. Black: Nothing to disclose; P. Thorpe: Nothing to disclose; M. Passman: Nothing to disclose. Deep Venous Thrombosis Associated With Caval Extension of Iliac Stent E. Murphy, B. Johns, M. Alias, W. Crim, S. Raju. The RANE Center, Jackson, Miss Background: It is generally difficult to place an iliac vein stent “pre cisely” at the iliac caval junction with venographic control or even with IVUS guidance. This is because the anatomic junction is not circular but a tilted oval and the lesion whether primary or post thrombotic may variably encroach on the vena cava. We have advocated extending the stent 3 to 5 cm into the cava to prevent the lesion squeezing the stent distally or com pressing the end into a cone. This suggestion has met with resistance due to concerns of jailing contralateral iliac flow and subsequent deep venous throm bosis (DVT). We analyzed DVT incidence following placement of Wallstent with caval extension as well as a modification where a Z stent on top of the Wallstent stack was used for the extension. With widely spaced struts, contra lateral jailing was less likely to occur in addition to other technical benefits. Methods: A total of 755 limbs with consecutive Wallstent caval ex tensions (2007 to 2011) and 982 limbs with Z stent extensions (2011 to 2015) were analyzed for DVT incidence. Fisher exact test was used for sta tistical comparison. Results: Patient demographics were similar for both groups. The mean age was 58 years old; 68% female and 32% male; 61% of patients left side, and 39% right side. Patient pathology: 52% PTS only, 35% MTS only, 13% had both MTS and PTS. DVT incidence is shown in the Table. Left sided DVT was more common overall and in either group (P < .003). l teral s Ipsilateral DVT (<30 days) Ipsilateral DVT ($30 days) Total Ipsilateral DVTs Total DVTs 9 26 12 38 57 * 6*** 3** 9*** 12***