Intravascular ultrasonography The Phlebology Clinic / Services / Intravascular ultrasonography Introduction Scope of service Preparation Specialists Frequently asked questions Introduction Intravascular ultrasonography (English. intravascular ultrasound, IVUS) is a technique for imaging the inside of venous and arterial vessels. Phlebology uses a small ultrasound probe inserted directly into the lumen of a venous vessel from a percutaneous access. The intravascular probe emits ultrasound waves that allow a very precise image of its structure from the inside. Intravenous ultrasonography is always performed in conjunction with digital phlebography, providing a valuable adjunct to diagnostic imaging in diseases of the venous system. It should be emphasised that intravascular ultrasound is not the examination of first choice - it has an auxiliary role in diagnosis and treatment planning, especially in cases requiring precise assessment of vascular lesions. What does the IVUS study include? insertion of a small longitudinal ultrasound probe into the vessel, which emits an acoustic wave and allows detailed imaging of the venous vessel lumen; imaging of the morphology of the vessel lumen and surrounding anatomical structures in cross sections; assessing the influence of arteries or other external structures on the course of the veins; identification of abnormalities of vascular development, fibrosis, vascular septa and post-thrombotic changes; in the case of stent procedures, assistance in selecting the type of equipment. IVUS examination Price of service: From £8500 Duration: 30-90 min. Make an appointment What are the indications for the use of IVUS? Indications for IVUS in modern phlebology include: diagnosis of venous compression phenomena in the large vessels (e.g. in May-Thurner syndrome); assessment of dynamic external compression on the venous trunk - such phenomena may be overlooked in static venography; Identification of intravenous adhesions, septa and intravenous scarring resulting from congenital or acquired changes following venous thrombosis; assessment of a developed post-thrombotic syndrome - especially when difficult-to-heal venous ulcers are present; Venous stent implantation planning - IVUS helps to select the correct size of the stent and its precise positioning; follow-up after venous stent placement to assess its proper expansion and adhesion to the venous vessel walls What are the limitations of intravascular ultrasound? The use of IVUS during diagnostic phlebography, during balloon angioplasty or balloon angioplasty with subsequent venous segment stenting always increases the time of the surgical procedure. However, there are several other disadvantages and limitations of this imaging method, which requires entering the venous vessel through more than 8 Fr of vascular sheath (for Visions PV 0.035), the most common of which are: IVUS is part of phlebographic imaging, requiring the administration of a contrast agent; does not allow sufficient assessment of the tissues and organs surrounding the venous vessel; the need to place the catheter tip in the centre of the vessel parallel to its long axis (difficult in tortuous and post-thrombotic vessels); obtaining high-resolution images is still a challenge; inability to assess collateral circulation and venous vessels that are difficult to access with the catheter and probe; various artefacts generated during the examination (e.g. due to patient movement, "ring-down"); the rather high cost of the procedure and equipment (the use of IVUS increases the cost of the procedure); possible bias in the assessment of the degree of stenosis due to complex haemodynamic conditions; How does the IVUS examination proceed? Preparation for IVUS is identical to that for phlebography. Access to the venous vessels is obtained by Seldinger technique through a small percutaneous puncture under local anaesthesia. At the Phlebology Clinic, each access to a venous vessel is performed under ultrasound guidance, so we avoid complications arising from dilatation or puncture. A thin, elongated probe that emits ultrasound waves is then inserted into the venous system. This allows an image to be obtained on a monitor. The IVUS examination is always accompanied by phlebography, which is not as a map for its performance. The IVUS is carried out under the conditions of admission to the hospital ward. At the end of the examination, the doctor removes the IVUS catheter and probe and advises the patient to rest in a supine position. During the examination, the doctor continuously evaluates the images to optimise the information obtained and accurately visualise the vessel from the inside. The images obtained are saved to allow further analysis and treatment planning. Consulting specialists dr n. med. Cezary Szary - phlebologist, radiologist Phlebology, Radiology and Imaging Diagnostics Dr Dominika Plucińska - phlebologist, radiologist radiology and diagnostic imaging, phlebology Tomasz Grzela, MD - phlebologist, surgeon General surgery, phlebology dr n. med. Jerzy Leszczyński - vascular surgeon General surgery, vascular surgery dr n. med. Justyna Wilczko – flebolog, internista Phlebology, internal medicine, radiology and diagnostic imaging Dr Krzysztof Celejewski - phlebologist, surgeon general surgery, phlebology dr n. med. Łodyga Małgorzata - phlebologist, cardiologist cardiology, phlebology, Doppler ultrasonography Dr Marcin Napierała - phlebologist, surgeon general surgery, phlebology Mostlyquestions asked Is IVUS examination safe? IVUS is considered safe and the risk of complications is very low (less than 1%). The use of the ultrasound-guided access technique significantly minimises the risk of complications associated with venipuncture and insertion of the ultrasound probe into the vascular catheter. Is the IVUS examination painful? IVUS - like phlebography - is performed from a percutaneous access under local anaesthesia, which minimises patient discomfort. The insertion of the catheter itself may cause a slight pressure sensation, but should not be painful. Does IVUS help avoid unnecessary venous stenting? In our experience, when the diagnosis is made accurately (after Doppler ultrasound of the abdominal and pelvic veins, MR venography and intraoperative phlebography), it does not happen that an experienced radiologist and interventional radiologist misjudges the indications for stenting. On the contrary, it is the use of IVUS that often gives an image of apparent stenosis and does not allow a proper assessment of the haemodynamic conditions and the extent of the resulting collateral circulation. Is the use of IVUS necessary during vein stenting surgery? In the experience of the doctors at the Department of Phlebology, intravascular ultrasound (IVUS) is not necessary to perform vein unblocking, dilatation and stenting. It can help in order to accurately assess stenosis, especially in the iliac veins, but does not significantly improve treatment results. The use of an IVUS probe increases the cost of the procedure. How long does an IVUS study take? The IVUS diagnostic examination itself usually takes between 20 and 45 minutes. This time may vary depending on the extent and complexity of the examination. If it is part of a surgical procedure (e.g. balloon angioplasty with insertion of stent(s) into a thrombosed vein), the time may extend to 2-3 hours. Dr Venus: virtual patient counsellor Looking for an answer to your vein question? Ask our Dr. Venus! Ask Dr Venus a question Can you help me diagnose the condition? Hello, please tell us your most your most frequent complaints. 01 / Vascular spider veins Dilated subcutaneous capillaries and reticular veins are a common symptom heralding the development of venous insufficiency. Their occurrence should not be underestimated. 02 / Varicose veins of the lower limbs They are the most common symptom of venous insufficiency of the lower limbs. Their occurrence should not be underestimated. At the Phlebology Clinic, we treat venous disease causally. 03 / Venous edema of the shin An enlargement of the shin circumference that increases in the evening, accompanied by a feeling of heaviness, is usually a symptom of venous insufficiency. Think about having a venous Doppler ultrasound examination! 04 / Pelvic venous insufficiency Painful and prolonged periods, heaviness in the legs during menstruation, pain during intercourse and burning in the intimate area are just some of the symptoms of pelvic venous insufficiency. Find out more! 05 / Venous compression syndromes It is a group of anatomically determined venous disorders leading to early onset of pelvic venous insufficiency and varicose veins on the legs. It affects both ladies and gentlemen! 06 / Venous disease in pregnancy Not sure when to start wearing compression stockings? Do you suspect vulvar varicose veins or have noticed sudden swelling of a limb during pregnancy! Don't wait to develop venous disease - consult our phlebologist for your symptoms. 07 / Varicose veins of the spermatic cord Up to 40% cases of male infertility may be related to varicose veins of the seminal vagina. This form of pelvic venous insufficiency is one of the more common causes of varicose veins on the legs and a cause of discomfort in the groin and scrotum. Early diagnosis increases the chance of a full cure! 08 / Venous thrombosis Swelling of the leg, pain and redness are alarm signals that should not be ignored. Venous thrombosis is an emergency condition that requires immediate diagnosis by Doppler ultrasound. If untreated, it can lead to life-threatening pulmonary embolism. 01 / 08 Modern vein treatment We offer treatment both on an outpatient basis and in day ward admissions. The stay is of short duration. The patient spends between 1 and 5 hours in the Clinic. Make an appointment Make an appointment at the Phlebology Clinic Make an appointment for a consultation
