can advanced venographic techniques substitute ivus?
TRANSCRIPT
PowerPoint-PräsentationOlivier HARTUNG, MD
Disclosure Speaker name:
I have the following potential conflicts of interest to report:
x Consulting
Other(s)
Speaker name:
Olivier HARTUNG
I have the following potential conflicts of interest to report:
x Consulting
Other(s)
History
• Improved since DSA (digital subtraction angiography)
Modern angiographic suites
• Multiple angulations… or even rotational angiography and cone beam CT (irradiation!!!)
• Better definition and large screen
• Less irradiation
• Fusion techniques
• Multiples curves in the pelvis
• Collateral washout
Duplex scan
• Diagnostic +++
• Evaluation of caudal involvement • Absence of flow + not compressible • B flow for low flow and intraluminal lesions
• Echo-guided puncture
Advantages
• Anatomical variations and compressions
• Cephalic extension, lesion’s length • Other lesions (cancer) • MRV for thrombus aging and
susceptibility to lysis • Procedure planification
• Stent length
Drawbacks
• Artifacts
• Spatial resolution? Webs?
• No X rays
• Circumferential assessment of the lumen and of the wall • Collaterals, adjacent structures (arteries…) • Measurement (diameter, area) • Quality of the wall (echogenicity)
• Landing zones, location of ilio-caval confluence
• Evaluate the results (stent apposition, in stent area…)
• But no hemodynamic evaluation (to date…)
Raju JVSVLD 2021 : 3D CTV vs IVUS
• Luminal areas : underestimate Civ and EIV, overestimate CFV • CIV 0,89 (difference 0,9mm2), EIV 0,77 (11,5mm2), CFV 0,69 (-17,5mm2)
• Obstruction : overall accuracy CIV 91%, EIV 86%, CFV 82%
• Stent : • Diameter : within 2mm in 91%, 4mm in 100%
• Length : CT underpredict -9,5mm (-48 to +45…)
Conclusion • Advanced Imaging techniques can help to plannify the procedure
• Lesion's extension
• Preselect balloon and stent size
• And during recanalization • Fusion from CTV or MRV, cone beam CT => catheterize the good channel
• But IVUS is superior once recanalization performed • Real time exam • Intraluminal lesions (webs), collaterals (deep femoral vein) • Sizing and landing zone • Result evaluation
=> Multimodality image acquisition and guidance in an integrated platform
Slide 1
Slide 2
Slide 9
Slide 10
Slide 11
Slide 12
Conclusion
Disclosure Speaker name:
I have the following potential conflicts of interest to report:
x Consulting
Other(s)
Speaker name:
Olivier HARTUNG
I have the following potential conflicts of interest to report:
x Consulting
Other(s)
History
• Improved since DSA (digital subtraction angiography)
Modern angiographic suites
• Multiple angulations… or even rotational angiography and cone beam CT (irradiation!!!)
• Better definition and large screen
• Less irradiation
• Fusion techniques
• Multiples curves in the pelvis
• Collateral washout
Duplex scan
• Diagnostic +++
• Evaluation of caudal involvement • Absence of flow + not compressible • B flow for low flow and intraluminal lesions
• Echo-guided puncture
Advantages
• Anatomical variations and compressions
• Cephalic extension, lesion’s length • Other lesions (cancer) • MRV for thrombus aging and
susceptibility to lysis • Procedure planification
• Stent length
Drawbacks
• Artifacts
• Spatial resolution? Webs?
• No X rays
• Circumferential assessment of the lumen and of the wall • Collaterals, adjacent structures (arteries…) • Measurement (diameter, area) • Quality of the wall (echogenicity)
• Landing zones, location of ilio-caval confluence
• Evaluate the results (stent apposition, in stent area…)
• But no hemodynamic evaluation (to date…)
Raju JVSVLD 2021 : 3D CTV vs IVUS
• Luminal areas : underestimate Civ and EIV, overestimate CFV • CIV 0,89 (difference 0,9mm2), EIV 0,77 (11,5mm2), CFV 0,69 (-17,5mm2)
• Obstruction : overall accuracy CIV 91%, EIV 86%, CFV 82%
• Stent : • Diameter : within 2mm in 91%, 4mm in 100%
• Length : CT underpredict -9,5mm (-48 to +45…)
Conclusion • Advanced Imaging techniques can help to plannify the procedure
• Lesion's extension
• Preselect balloon and stent size
• And during recanalization • Fusion from CTV or MRV, cone beam CT => catheterize the good channel
• But IVUS is superior once recanalization performed • Real time exam • Intraluminal lesions (webs), collaterals (deep femoral vein) • Sizing and landing zone • Result evaluation
=> Multimodality image acquisition and guidance in an integrated platform
Slide 1
Slide 2
Slide 9
Slide 10
Slide 11
Slide 12
Conclusion