Intravascular ultrasound (IVUS - intravascular ultrasound) is more accessible nowadays. Thus, it is more frequently used to examine the venous system, especially such veins as: inferior vena cava, iliac veins and femoral veins.

In case of IVUS, access to veins is provided via the Seldinger technique which consists in a slight percutaneous puncture under local anesthesia.

Then, a small transducer emitting mechanical waves is inserted to the venous system. Therefore, the picture visible on the screen is close to the classic ultrasound. Imaging of the vessel from the inside allows for an incredible precise assessment of potential blockages such as postthrombotic narrowings or partitions, which are frequently imperceptible via other imaging examinations.

IVUS is more frequently used as a supplement to or additional verification of classic phlebography. From recent studies transpires that due to the combination of these two methods, the percentage of diagnosed postthrombotic syndromes or occlusions produced in nonthrombotic mechanism within iliac-femoral segment amounts to more than 90% (versus 50-60% for classic phlebography performed separately). It is often the case that IVUS is performed following MRI or CT venography. 

Nowadays, the most common indications for intravascular ultrasound are:

  • suspicion of limited venous outflow in iliac vessels in the mechanism of primary obturation (e.g. May-Thurner syndrome)
  • follow-up for venous stent implantation
  • advanced post-thrombotic syndrome (e.g. poorly-healing leg ulceration) 
  • planned venous stent implantation

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