Objectives
Intravascular ultrasound (IVUS) is the preferred method for diagnosing iliocaval deep venous stenosis (DVS). Preoperative cross-sectional imaging (CSI) is used to screen for DVS in selected patients, but there is no current standardization of radiological measurement and reporting. Our hypothesis is that discordance in CSI interpretation between vascular specialists and radiologists could impact patient care and outcomes.
Methods
A retrospective analysis of patients who underwent deep venous stenting after CSI for chronic venous symptoms was performed. Vascular specialists reviewed all CSI scans for significant DVS (≥50%) and compared them with the official radiologist reports. Patients were divided into two groups based on the interpretation of CSI: discordant reading (DR) and concordant reading (CR). The DR group consisted of cases where the vascular specialists' interpretation differed from that of the radiologist, whereas the CR group included cases where there was agreement.
Results
Ninety-three patients underwent stenting for DVS with preoperative CSI, and 27% had DR. There were more female patients in the CR group, with no other demographic differences. There were significantly more patients in the CR group with a history of anticoagulation use than patients with DR. There was no difference in presenting symptoms based on CEAP clinical classification between the two groups. MRI was the most used CSI modality (64.5%), with no difference between the groups. There was a significantly higher proportion of patients with common iliac vein (CIV) stenosis in the DR group compared with the CR group reaching up to 96%, suggesting that the interpretation of significant CIV stenosis is the source of most discordances. IVUS revealed significant iliac vein stenosis in the majority of patients (96.8%) regardless of CSI. After a mean follow-up of 2.5 years, both groups had similar symptomatic relief (95% vs 98%; P = .5) (Table) and primary patency (Fig).
Conclusions
This study reveals significant discordance between vascular specialists and radiologists in the interpretation of CSI of DVS related mostly to measurement of the CIV. Even though patients had excellent outcomes in both groups, standardization of measurement and reporting of DVS on CSI could improve patient selection for therapy.
