Intravascular Ultrasound in the diagnosis and treatment of chronic cerebrospinal venous insufficiency

Use of IVUS for balloon selection (Table 1, Figure 10)

Balloon sizing is a great challenge in treating stenoses of the internal jugular veins. Unlike the azygous vein and arteries which have a relatively uniform circular shape, the internal jugular veins do not. They may have a round, oval or multifaceted shape. Venography cannot accurately detect these shapes without the use of multiple views. Moreover, maximum and minimum diameters may be so disparate that simple estimates may grossly underestimate or overestimate the balloon size selection. Because these stenoses usually require large balloons and high pressures, improper sizing may result in serious complications such as dissection, tears and occlusions or inadequate distension and ineffective treatment.

Analysis by IVUS makes quite clear the deficiencies of venography. The cross sectional anatomy of the vein and the variation of size based on phase of respiration may it clear that cross sectional area (circumference) is the superior criteria for assessing size of the vein and for selecting the appropriate balloon for venoplasty or valvuloplasty.