Author: Prof. Dr. Houman Jalaie

Institution: European Venous Center, University Hospital Aachen, Germany

Summary

This presentation discusses how intravascular ultrasound (IVUS) technology is used to determine the optimal landing zone during venous stent placement. By analyzing the principles of landing zone positioning and the use of IVUS preoperatively, intraoperatively, and postoperatively, this presentation highlights the critical role of IVUS in venous treatments, especially in cases of venous compression and complex thrombotic conditions.

Determining the Landing Zone

• Proximal Landing Zone: IVUS can accurately identify the proximal landing zone, which is crucial in preventing stent migration and retrograde venous compression. The proximal landing zone is typically located at the inferior vena cava (IVC) confluence and requires a 10-12 cm stent to ensure stability.

• Distal Landing Zone: The distal landing zone is usually positioned at the entrance of the deep femoral vein (DFV). IVUS helps detect valves or trabeculae that may obstruct the main inflow vein, and percutaneous transluminal angioplasty (PTA) is used to ensure proper blood flow.

Intraoperative Application of IVUS

• Intraoperative Guidance: IVUS provides real-time visualization of the highest pressure points in the vein and accurately assesses venous compression through crossover venography. Before stent placement, IVUS helps prevent compression of the contralateral iliac vein.

•Postoperative Assessment: IVUS is used to evaluate the success of stent placement, ensuring no adverse effects on surrounding veins. On the day of discharge, IVUS and Doppler ultrasound (DUS) are typically used to measure stent diameter and area to confirm successful treatment.

Case Study

• Case: Acute In-Stent Thrombosis Post-Surgery: Two weeks post-surgery, a patient developed acute in-stent thrombosis. IVUS revealed trabeculae obstructing the main inflow vein. PTA was used to successfully break the trabeculae and restore blood flow.

Conclusion

1. The use of IVUS in venous stent placement is critical for accurately determining the best proximal and distal landing zones, ensuring a high success rate for the procedure.

2. Postoperative monitoring with IVUS allows early detection and management of stent obstructions and thrombotic issues, reducing postoperative complications.

3. IVUS offers unique advantages in managing complex thrombotic lesions, improving surgical precision and patient outcomes.

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