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Policy Aetna considers intravascular ultrasound IVUS medically necessary for any of the following situations: Aetna considers the clinical application of IVUS experimental and investigational for any of the following not an all-inclusive list because its use for these indications has not been validated by clinical studies: Background Angiography is limited in determining the anatomic severity of coronary artery stenoses because it represents only a projectional image of the vessel lumen without providing any information concerning vascular wall architecture.

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Catheter-based intravascular ultrasound IVUS has been developed in the last few years to provide this unique perspective Midterm review 399 viewing vascular disease and the effects of intervention. As a complement to the information provided by coronary angiography, it has the unique ability to study vessel wall morphology in vivo, accurately displaying the details of vessel structure and tissue characterization by providing such critical information as the presence and degree of calcified plaque, quantifying luminal dimensions, and characterizing the composition of stenotic lesions into soft plaque, hard plaque, calcification, and type of thrombus.

Although these devices have only been available for a relatively short time, an array of studies demonstrating numerous diagnostic and therapeutic applications in interventional cardiology have been reported. The maturity of the technology is such that IVUS currently has a place as a clinical decision-making tool in patients with symptoms and intermediate lesions, as a provisional study to assess left main stem disease suspected but not disclosed by coronary angiography, and as a method for both guidance of endoluminal devices and immediate assessment of the results of therapeutic techniques, including balloon angioplasty, atherectomy, and intravascular stent deployment.

More research is needed to answer some important questions regarding the whole array of potential applications of IVUS. Newer developments under scrutiny include combined devices, looking-forward ultrasound, high-frequency probes, imaging wires, tissue characterization and three dimensional 3-D technology.

Its use in peripheral vascular disease remains as a research tool for investigation of blood vessel compliance, dynamic changes in the vessel wall caused by disease or pharmacologic intervention, and elucidation of the morphologic changes associated with the natural history of atherosclerosis.

It has not been proven that changes in treatment made based on the results of intravascular ultrasound improve health outcomes in patients with non-coronary vascular diseases.

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Intravascular ultrasound has been used as a guidance for for placement of inferior vena cava filters. Ashley et al reported that IVUS is a more accurate method of localizing the renal veins and measuring vena cava diameter for placement of vena cava filters than contrast venography.

Mathews et al noted that imaging of the vena cava prior to the insertion of an inferior vena cava IVC filter is mandatory to assess IVC diameter and patency, delineate anatomy and venous anomalies, and to direct filter placement for appropriate deployment and avoidance of complications.

The standard imaging technique is vena cavography, although alternative methods to evaluate the IVC include carbon dioxide venography, trans-abdominal duplex ultrasound, and IVUS.

Wellons et al stated that reports have demonstrated the benefit of prophylactic inferior vena cava filter IVCF placement to prevent pulmonary embolism.

The randomized TAXUS II trial evaluates the polymer-based paclitaxel-eluting Taxus stent in slow- and moderate-release formulations. Tsuchida et al () examined the consistency between angiographic and IVUS outcomes of late lumen loss (late loss) and neointimal growth to measure restenotic plaque load in Taxus and BMS. Academic Policies Academic Honesty. Just as the faculty, staff and administration at Whitworth strive to be forthright, direct and honest and to value integrity in all their dealings, the university expects all students to function in like manner. We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

All patients had ultrasonography of the femoral veins after placement to rule out post-procedure femoral vein thrombosis and radiographs to identify filter location. Within 3 weeks of placement, 12 IVCFs were retrieved. Of the remaining 8 patients, 6 had indications for permanent implantation, 2 had contralateral deep venous thrombosis, and 1 had ipsilateral deep venous thrombosis.

Passman et al stated that bedside placement of ICVF by using either trans-abdominal duplex ultrasonography or IVUS has been shown to be safe and effective. The authors reviewed techniques for bedside filter placement with trans-abdominal duplex ultrasonography, IVUS with dual venous access, and IVUS with single venous access.

They noted that trans-abdominal duplex ultrasonography and IVUS remain their preferred techniques for filter placement when feasible, especially in critically ill and immobilized patients.

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The objectives of the study were 2-fold: These researchers enrolled patients with de novo coronary lesions treated with single, greater than 2. The PES achieved Lesion morphology, arc and length of calcium, stent diameter and length, and implantation pressures did not affect expansion.

A considerable percentage of DES does not achieve minimum standards of stent expansion. However, stent expansion can not be predicted from pre-intervention IVUS lesion assessment. Tsuchida et al examined the consistency between angiographic and IVUS outcomes of late lumen loss late loss and neointimal growth to measure restenotic plaque load in Taxus and BMS.

For this sub-analysis, quantitative coronary angiographic QCA and IVUS measurements were used to derive late loss and neointimal volume. From after the procedure to 6 months, QCA and IVUS showed matching results for the 2 groups with significant decreases in late loss and neointimal volume in the Taxus versus the control group.

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From 6 months to 2 years, QCA and IVUS measurements also showed results similar to those in the control group, demonstrating neointimal compaction over time. The authors concluded that although QCA and IVUS results were similar over the first 6 months, long-term assessment of changes in re-stenotic plaque load showed discrepant findings for the Taxus stent.Academic Policies Academic Honesty.

Just as the faculty, staff and administration at Whitworth strive to be forthright, direct and honest and to value integrity in all their dealings, the university expects all students to function in like manner.

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