Impact of intravascular ultrasound during endovascular interventions for chronic venous insufficiency with active venous stasis ulcers

Sunday, March 30, 2025

3:27 PM – 3:36 PM CT

Location: Music City Center, 202 BC

Presenting Author(s)

Michael Semanek, MA (he/him/his)

Medical Student
University of Pennsylvania Perelman School of Medicine, United States

Author/Co-author(s)

Ansar Z. Vance, MD

Attending Physician
University of Pennsylvania, United States
DD

David W. D'Angelo, DO

Medical Director, Wound Care
University of Pennsylvania, United States
DP

Douglas Pugliese, MD, MPH

Associate Professor of Medicine
University of Pennsylvania, United States
Timothy W. Clark, MD, FSIR

Professor of Clinical Radiology; Director of Interventional Radiology
University of Pennsylvania; Penn Presbyterian Medical Center, United States

Purpose: To evaluate the impact of intravascular ultrasound (IVUS) during endovascular interventions for chronic venous insufficiency (CVI) with active venous stasis ulcers (VSU) on ulcer healing, stent placement rates, clinical severity scores, and healthcare utilization.

Materials and Methods: This single-center retrospective analysis included patients with CEAP class 6 disease (active VSU) undergoing endovascular intervention between June 2010 and May 2024. Patients were divided into two groups: 1) IVUS-guided intervention and 2) non-IVUS guided intervention. The primary outcome was ulcer healing, defined as achieving a CEAP class 5 (healed ulcer). Secondary outcomes included iliac venous stent placement rates, changes in Venous Clinical Severity Score (VCSS), VCSS sub-category ulcer size score, and number of wound-related home health visits per patient-year. Fisher's exact test and the Wilcoxon Rank Sum test were used for intergroup comparisons.

Results: A total of 178 patients were included (IVUS Intervention = 83, non-IVUS = 95). Ulcer healing was achieved in 27% of IVUS patients and 12% of non-IVUS patients (P = 0.02, odds ratio 2.8). Iliac venous stents were placed in 78% of IVUS patients and 35% of non-IVUS patients (P < .001). 23% of patients that received stents had their ulcers healed, while only 13% of those without stents healed (P = 0.15, odds ratio 1.9). The IVUS group required 24.3 home health visits per patient-year, while the non-IVUS group required 37.8 home health visits per patient-year (P= 0.06). Mean VCSS decreased from 18.7 to 14.3 in the IVUS group and from 18.3 to 18.2 in the non-IVUS group (P = 0.08). Mean ulcer size score decreased from 2.50 to 1.69 in the IVUS group and from 2.19 to 1.97 in the non-IVUS group (P < .001).

Conclusion: Improved ulcer healing rates and greater reductions in ulcer size were observed in patients undergoing IVUS-guided intervention for CVI and VSU, with a higher rate of stent placement but fewer wound-related home health visits compared to venography alone. These findings suggest routine use of IVUS for CVI is cost-effective.