Diagnostic yield of intravascular ultrasound in patients with clinical signs and symptoms of lower extremity venous disease.

Background: Intravascular ultrasound (IVUS) examination has a higher sensitivity compared with venography in the assessment of obstructive venous disease. However, at most venous centers, both modalities continue to be used concomitantly. This study evaluated the diagnostic clinical yield of IVUS examination as a singular intraoperative investigative modality in patients in whom clinical signs and symptoms of venous disease were severe enough to merit such an examination and in whom a venogram was not performed simultaneously.

Measurement of ambulatory venous pressure and column interruption duration in normal volunteers.

Background: Ambulatory venous pressure (AMVP) measurement is considered the gold standard in evaluating calf pump function in chronic venous disease. The AMVP protocol was standardized in the 1970s with pressure monitoring through the dorsal foot vein. This technique was based on the belief that it represents calf venous pressure dynamics owing to rapid equilibration in the superficial and deep systems.

Ambulatory venous pressure, air plethysmography, and the role of calf venous pump in chronic venous disease.

Background: Ambulatory venous pressure (AMVP) records pressure dynamics with calf exercise. Air plethysmography (APG) measures related volume detail. APG has been suggested as a noninvasive surrogate for AMVP.

Caliber-targeted reinterventional overdilation of iliac vein Wallstents.

Background: Wallstents (Boston Scientific, Marlborough, Mass) are most commonly used in iliac-caval stenting. Approximately 20% of stented limbs require reintervention to correct in-stent restenosis (ISR) or stent compression (SC). Corrective balloon dilation to rated stent caliber (isodilation) is not always successful.

A systematic review of the efficacy and limitations of venous intervention in stasis ulceration.

Background: Surgical techniques to address various components of chronic venous disease are rapidly evolving. Their efficacy and generally good results in treating superficial venous reflux (SVR) have been documented and compared in patients presenting with pain and swelling. A growing amount of literature is now available suggesting their efficacy in patients with venous leg ulcer (VLU).

Optimal sizing of iliac vein stents.

Background Iliac vein stenting has emerged as a therapeutic option in chronic venous disease. The optimal stent size is unknown but should match normal caliber at a minimum. Methods Teleology: The iliac-femoral outflow caliber was measured by Duplex in healthy volunteers to determine normal caliber.

Deep venous thrombosis associated with caval extension of iliac stents.

Background: It is generally difficult to place an iliac vein stent precisely at the iliocaval junction with venographic control or even with intravascular ultrasound guidance. Furthermore, mechanical properties of the Wallstent (Boston Scientific, Marlborough, Mass) can predispose precisely placed stents to distal displacement or stent collapse. Our center has thus advocated extending Wallstents 3 to 5 cm into the inferior vena cava to prevent complications of missed proximal lesions or stent migration.

Effect of External Positive and Negative Pressure on Venous Flow in an Experimental Model.

Objective: Positive external pressure is said to decrease transmural pressure; negative pressure in the pleural cavity is widely believed to result in negative pressure in systemic chest veins. The discrepancy between erect column height and foot venous pressure has been explained on this basis.

Methods: These core concepts rest on static closed models that may not be appropriate.

Utility of iliac vein stenting in elderly population older than 80 years.

Background: The geriatric population aged 80 years and older with severe manifestations of chronic venous disease face diminishing therapeutic options. Self-applied compression is often not possible because of frailty or arthritis. Significant limb swelling diminishes mobility, affects independent living, and precipitates institutionalization.

Quantifying saphenous reflux.

Background: Quantification of reflux is desirable in advanced chronic venous disease as clinical features are based on its adverse impact on ambulatory venous pressure (AMVP). Prior clinical observation suggests that reflux in a saphenous vein > 5 mm is likely significant. On the basis of normal calf pump mechanics, we hypothesized that a reflux volume ≥ 30 mL was necessary to upset pump equilibrium.

Anomalous features of iliac vein stenosis that affect diagnosis and treatment.

Background: Endovenous management of venous lesions is largely derived from arterial experience. However, venous lesions, particularly iliac vein stenoses, differ from their arterial counterparts in some crucial respects. Awareness of these differences is necessary for proper diagnosis and treatment.

Assessment of residual thrombus after venous thrombolytic regimens.

Background: We noticed substantial residual thrombus on intravascular ultrasound (IVUS) in many limbs despite restoration of flow after thrombolysis. Since thrombus burden has been tied to post-thrombotic syndrome (PTS), the frequency and extent of residual thrombus after thrombolysis is important. We present such an analysis below.

A modification of iliac vein stent technique.

Background: Iliac vein stenting has emerged as a promising new technology to address a wide spectrum of advanced chronic venous disease. Wallstent™ has been the commonest stent type used in reported experience. It has excellent long-term patency with good clinical outcome, but is prone to compression/migration of the upper end of the stent requiring reinterventions.