Effectiveness of 2D-DSA and 3D-DSA in the Evaluation of Iliac Vein Stenosis: A Multicenter Prospective Study

To compare the sensitivity of measuring iliac vein stenosis using two-dimensional digital subtraction angiography (2D-DSA) and three-dimensional digital subtraction angiography (3D-DSA), with multidetector computed tomography venography (MDCTV) as the reference standard.

Between January 2020 and January 2023, a total of 103 patients suffered from chronic venous insufficiency symptoms categorized as CEAP Level 3 or above were included from three centers. These patients were admitted to our hospital after abdominal vascular ultrasound and MDCTV positivity. During hospitalization, all patients underwent both 2D-DSA and 3D-DSA procedures simultaneously. Ensure double-blind and rigorous evaluation process when evaluating images. All patients were categorized into two groups based on the degree of CTV stenosis: Group A (50%-70%) and Group B (>70%). Considering the morphology of iliac vein compression, all patients were categorized into three groups: central, lateral, and partial obstruction. Subsequently, the effectiveness analysis was performed for each diagnostic method based on the aforementioned classification.

With MDCTV as the reference standard, in Group A, the sensitivity of 2D-DSA and 3D-DSA is 78.69% and 90.48%, respectively. In Group B, the sensitivity of 2D-DSA and 3D-DSA is 93.44% and 97.62%, respectively. In Group A, the accuracy of 3D-DSA is significantly higher than that of 2D-DSA (p = 0.019). However, there is no statistically significant difference in Group B (p = 0.360). The accuracy rates for central, lateral, and partial obstruction using 2D-DSA are, respectively, 77.55%, 69.70%, and 95.24%. The accuracy rates for central, lateral, and partial obstruction using 3D-DSA are, respectively, 93.88%, 93.94%, and 100%. In central group, the accuracy of 3D-DSA is significantly higher than that of 2D-DSA (p = 0.021). In lateral group, no significant difference was observed between the accuracy obtained by both methods (p = 0.011). Similarly, no significant difference was found in partial obstruction group (p = 1.000). During the angiography procedure using 3D-DSA, a significant reduction was observed in both contrast agent quantity and exposure time (p < 0.05) without any apparent effects on renal function.

Regardless of the degree or type of iliac vein stenosis, 3D-DSA exhibits superior sensitivity compared to 2D-DSA for the diagnosis and evaluation of stenosis. Particularly in instances of noncentral stenosis, 3D-DSA outperforms 2D-DSA.Clinical ImpactThis will provide new insights for the clinical diagnosis and treatment of iliac vein compression syndrome (IVCS), significantly enhancing the diagnostic accuracy of IVCS. For clinicians, three-dimensional digital subtraction angiography (3D-DSA)offers a more comprehensive and detailed assessment in clinical practice, leading to more precise diagnosis and treatment of the disease. The efficacy of two-dimensional digital subtraction angiography (2D-DSA) in treating IVCS is significantly compromised without the guidance from computed tomography venography (CTV). We consider that 3D-DSA can replace CTV in both diagnosis and treatment, providing a new diagnostic and therapeutic strategy.