Validation of venous duplex ultrasound imaging in determining iliac vein stenosis after standard treatment of active chronic venous ulcers

A case of duplicated inferior vena cava with bilateral iliac vein compression

Duplicated inferior vena cava with bilateral iliac vein compression is extremely rare. We report a case of an 87-year-old man presented with bilateral lower extremity swelling, who was noted to have duplicated inferior vena cava, as revealed by computed tomography angiography (CTA). This revealed bilateral iliac vein compression caused by surrounding structures. Anticoagulant treatment combined with stent implantation completely alleviated this chronic debilitating condition during the follow-up of 2 months with no recurrence.

May Thurner syndrome: Sixty years later

May-Thurner syndrome (MTS) was described sixty years ago. Once ignored for several years, it is currently a recognized pathology in the vascular surgery community; but not long ago due to several factors, it was underdiagnosed and sub-optimally treated. In the last 20 years, with renewed interest in venous pathology, technical imaging advances and the recent interventional procedures, it has become a better known disease. On the other hand, nowadays the easiness in diagnosis and treatment of the syndrome has lead to overtreatment of such patients. In this article, we do a historical review and describe the significant advances and current management of May-Thurner syndrome.

Transabdominal duplex ultrasound and intravascular ultrasound planimetry measures of common iliac vein stenosis are significantly correlated in a symptomatic population

OBJECTIVE

The objectives of the present study were to determine the validity of transabdominal duplex ultrasound (TAUS) against the reference standard of intravascular ultrasound (IVUS) examinations for the detection of iliac vein obstruction (IVO).

METHODS

We analyzed the data from patients at a private vascular laboratory who had undergone IVUS investigation with an intention to treat because of symptoms of chronic venous insufficiency and a high suspicion of IVO. These patients had also previously undergone a TAUS examination at the same location. The TAUS and IVUS planimetry measures of the left common iliac vein (CIV) were correlated. These included the TAUS-measured minimum and maximum diameter and the percentage of stenosis with the IVUS-measured minimum and maximum diameter and area and the percentage of stenosis.

RESULTS

The TAUS and IVUS data from 47 patients (83% female; age, 49.3 ± 17.3 years; 64% obese) were included in the analyses. We found 89% agreement between the TAUS and IVUS findings regarding the identification of left CIV stenosis of ≥50%. The TAUS data had a positive predictive value of 95.5%. The TAUS measures of the minimum diameter and percentage of stenosis correlated significantly with the IVUS measures of the minimum diameter, minimum area, and cross-sectional area of the percentage of stenosis. The strongest correlations were between the TAUS-measured minimum diameter and IVUS-measured minimum area and percentage of the area of stenosis according to the literature-derived value. The TAUS-measured vein diameter of 8 mm equated to an IVUS cross-sectional area of 94.2 mm² (53% stenosis), and an IVUS cross-sectional area of 50% of stenosis equated to a TAUS diameter of 8.56 mm.

CONCLUSIONS

The findings from the present study support the validity of TAUS evaluation as a workup diagnostic tool for the detection of IVO. Our findings also support the use of TAUS planimetry-in particular, the CIV diameter of ≤8 mm as a threshold value-to indicate clinically relevant stenosis and trigger an IVUS investigation with an intention to treat, because this correlated with a cross-sectional area stenosis of ≥50%, as determined by IVUS examination.

Using a modified Delphi methodology to gain consensus on the use of dressings in chronic wounds management

OBJECTIVE

Managing chronic wounds is associated with a burden to patients, caregivers, health services and society and there is a lack of clarity regarding the role of dressings in improving outcomes. This study aimed to provide understanding on a range of topics, including: the definition of chronicity in wounds, the burden of illness, clinical outcomes of reducing healing time and the impact of early interventions on clinical and economic outcomes and the role of matrix metalloproteinases (MMPs) in wound healing.

METHOD

A systematic review of the literature was carried out on the role of dressings in diabetic foot ulcer (DFU), and venous leg ulcer (VLU) management strategies, their effectiveness, associated resource use/cost, and quality of life (QoL) impact on patients. From this evidence-base statements were written regarding chronicity in wounds, burden of illness, healing time, and the role of MMPs, early interventions and dressings. A modified Delphi methodology involving two iterations of email questionnaires followed by a face-to-face meeting was used to validate the statements, in order to arrive at a consensus for each. Clinical experts were selected, representing nurses, surgeons, podiatrists, academics, and policy experts.

RESULTS

In the first round, 38/47 statements reached or exceeded the consensus threshold of 80% and none were rejected. According to the protocol, any statement not confirmed or rejected had to be modified using the comments from participants and resubmitted. In the second round, 5/9 remaining statements were confirmed and none rejected, leaving 4 to discuss at the meeting. All final statements were confirmed with at least 80% consensus.

CONCLUSION

This modified Delphi panel sought to gain clarity from clinical experts surrounding the use of dressings in the management of chronic wounds. A full consensus statement was developed to help clinicians and policy makers improve the management of patients with these conditions.