title: CT venography for deep venous thrombosis: can it predict catheter-directed thrombolysis prognosis in patients with iliac vein compression syndrome?
abstract: To evaluate the prognostic value of CT venography for catheter-directed thrombolysis (CDT) in iliac vein compression syndrome (IVCS) patients with deep venous thrombosis (DVT). The institutional review board approved this retrospective study and waived informed consent. Among the 201 consecutive patients treated in our interventional suite for DVT from January 2001 to June 2013, 48 IVCS patients (12 men, 36 women) who underwent pre-procedural CT venography, CDT with stenting, and follow-up imaging were analyzed. To identify possible determinants of 6-month patency, CT venography was evaluated with Fisher's exact test and logistic regression analyses. Based on the analyses, image-based criteria were established and compared to the current symptom duration-based approach by receiver-operating-characteristic curve analyses and the McNemar test. Recoiling of external iliac vein (EIV) diameter (<120 %) [hazard ratio (HR) 28.652, p = .007] and severe rim enhancement (HR 20.545, p = .016) were significant risk factors for venous occlusion within 6 months of CDT. The dual-parameter image-based criteria were significantly superior to the current symptom duration-based approach in terms of area under the curve value (p = .010) and predictive accuracy (p = .031). With a 2-point cut-off, the proposed criteria demonstrated a 66.7 % sensitivity, 100.0 % specificity, and 92.9 % predictive accuracy for identifying non-responders of CDT. CT venography may be useful in assessing CDT prognoses in IVCS patients, particularly to identify non-responders who demonstrate recoiling of EIV diameter and rim enhancement on CT venography.
authors.affiliation: Department of Radiology, Seoul National University Hospital, # 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
authors.forename: Jin Woo
authors.initials: JW
authors.lastname: Choi
authors.forename: Hwan Jun
authors.initials: HJ
authors.lastname: Jae
authors.forename: Hyo-Cheol
authors.initials: HC
authors.lastname: Kim
authors.forename: Sang-Il
authors.initials: SI
authors.lastname: Min
authors.forename: Seung-Kee
authors.initials: SK
authors.lastname: Min
authors.forename: Whal
authors.initials: W
authors.lastname: Lee
authors.forename: Jin Wook
authors.initials: JW
authors.lastname: Chung
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D002406:Catheterization, Peripheral / Q000295:instrumentation; D003251:Constriction, Pathologic; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging* / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D062108:May-Thurner Syndrome / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D010690:Phlebography / Q000379:methods*; D011237:Predictive Value of Tests; D012372:ROC Curve; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000295:instrumentation; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D062666:Vascular Access Devices; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000209:etiology
chemical_list: D005343:Fibrinolytic Agents