Abstract Background/Introduction Endovascular treatment (EVT) for deep vein thrombosis (DVT) is becoming increasingly common, with most procedures performed under angiographic guidance. Previous studies have reported clinical target lesion revascularization (CD-TLR) rates of approximately 9-12% and complication rates of 0-5%. However, reports on intravascular ultrasound (IVUS)-guided EVT remain scarce. This study is the first multicenter investigation in Japan to evaluate the safety and efficacy of IVUS-guided EVT for DVT. Purpose To assess the outcomes of IVUS-guided EVT in terms of procedural success, CD-TLR, and complications compared to non-IVUS-guided EVT. Methods DVT was initially diagnosed by computed tomography (CT), followed by venography to evaluate lesion characteristics. IVUS was used due to suspected iliac vein compression, post-angioplasty recoil, or other anatomical concerns. In Japan, as venous stents were not approved, arterial stents were used off-label. The primary outcome was CD-TLR, with secondary endpoints including procedural success rate, re-occlusion, and complication rates. Also, we analyzed in two groups IVUS group and non-IVUS. Results The mean follow-up duration was 550.4 days, with a mean patient age of 63.6 years. DVT was observed in the inferior vena cava in 28 cases, the isolated iliac vein in 4 cases, and the iliac-femoropopliteal vein in 42 cases. IVUS group was 44 cases (59%), and non-IVUS group was 30 cases (41%). EVT strategies included catheter-directed thrombolysis in 22 cases (30%) in the non-IVUS group and 19 cases (26%) in the IVUS group (P=0.020), balloon angioplasty in 23 cases (31%) in the non-IVUS group and 42 cases (58%) in the IVUS group (P=0.039), and stent implantation in 2 cases (2.7%) in the non-IVUS group and 21 cases (28%) in the IVUS group (P0.001). The CD-TLR rate was 2 cases (6.7%) in the non-IVUS group and 5 cases (11.4%) in the IVUS group (P=0.694), leading to an overall CD-TLR rate of 9.5%. The higher CD-TLR rate in the IVUS group may be attributed to the more complex lesions requiring stent placement. The complication rate was 0% in both groups. The type and length of stents used varied according to patient needs and lesion characteristics. The average stent diameter was 10.75 ± 1.79mm and the total stent length was146.1 ± 53.4mm. Conclusion(s) The use of IVUS-guided EVT resulted in favorable outcomes, demonstrating a CD-TLR rate (overall CD-TLR rate of 9.5%) comparable to previous reports despite the use of arterial stents instead of dedicated venous stents. These findings suggest that IVUS guidance may improve lesion assessment and optimize treatment outcomes. Future studies should focus on expanding patient cohorts and exploring the impact of IVUS-guided EVT with dedicated venous stents.iliac compression observed by IVUS Freedom from CD-TLR (overall)
Ichihara et al. (Sat,) studied this question.