Intravascular Ultrasound (IVUS) is a cutting edge, catheter based, ultrasound technology, which allows for precise identification of iliac vein obstructions as well as guidance for intravascular stent placement. The IVUS catheter is about the size of a tip of an ink pen, the end of which has a tiny ultrasound element which allows imaging of the vein from within.
IVUS enables us to directly examine the pelvic veins (iliac veins) which are responsible for draining the blood from the legs back to the heart. Obstruction of the iliac veins from external compression by the overlying iliac artery and the posteriorly located lumbar spine leads to high pressure in the veins below that point. Signs and symptoms of this increased pressure may include pelvic, buttock or hip pain which are typically worse after prolonged sitting or standing. Pelvic congestion syndrome occurs due to the development of cross pelvic collateral “varicose” veins, which may cause increased pelvic pain with menstruation, during or after intercourse(dyspareunia) or when lifting weight or bearing down as in squatting. Iliac vein compression may also contribute to recurrent venous complaints after previous vein ablation or previous vein stripping or excisions. Unexplained unilateral lower extremity edema, thickened & discolored lower leg skin and non-healing leg ulcers may also be caused by significant compression or obstruction of the iliac veins. Advancements in iliac vein ultrasound testing, as well as the application of ultrasound from within the actual vessel (IVUS), has enabled us to more accurately identify pelvic vein occlusive disease. Prior to IVUS there was not an accurate enough test to document iliac vein compression syndrome (IVCS) or post thrombotic (blood clot) iliac vein obstruction. Under IVUS direction, we can now identify disease previously not considered or recognized and offer appropriate patients definitive therapy with iliac stent placement which, with IVUS, can be sized accurately and confirmed to be fully expanded.