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Vascular and Intravascular Ultrasound

Intravascular ultrasound (IVUS) is a diagnostic test that uses sound waves to see inside blood vessels. It is useful for evaluating the coronary arteries that supply the heart.

A tiny ultrasound wand is attached to the top of a thin tube called a catheter. The catheter is inserted into an artery in your groin area and moved up to the heart. This is different from the conventional duplex ultrasound, which is done from the outside of your body.

A computer measures how the sound waves reflect off blood vessels and change the sound waves into pictures.

Who is eligible for a vascular and intravascular ultrasound?

IVUS imaging allows a doctor to see inside the arteries to understand the condition of the vessels. The procedure can reveal the plaque buildup or fat deposits in the arteries after it had previously been removed.

Your risk of heart attack increases as the fat builds up in the arteries. The information collected with IVUS can help your doctor develop an appropriate treatment plan. If you have any of the following conditions, you are NOT a candidate for IVUS:

  • Unstable blood flow.
  • Patients who have bacteremia or sepsis.
  • Patients who have abnormal bleeding issues.
  • Patients diagnosed with coronary artery spasm.
  • Patients who are not candidates for coronary artery bypass grafting surgery.
  • Patients who are not candidates for percutaneous transluminal coronary interventional procedures.
  • Patients who have a fully blocked artery (total occlusion).

What conditions can be diagnosed by a vascular and intravascular ultrasound?

In the veins, IVUS is most often used for spotting blood clots, especially if narrowing of the veins is thought to be the culprit. It can help find areas of narrowing deep in the body and can help measure the veins for stents to keep the vessel open.

In the arteries, IVUS usually examines the peripheral arteries of the legs and coronary arteries. It is often used with a catheter angiography to help diagnose peripheral artery disease and to plan the size of stents if there is plaque buildup (atherosclerosis).

It can also be used after angioplasty and vascular stenting to confirm the stent has been put in the right place. IVUS is also used to assess abdominal aortic aneurysm before, during and after interventions to repair the vessel.

How do I prepare for a vascular and intravascular ultrasound?

This procedure requires little or no special preparation since it is often used in conjunction with another procedure. Ask your doctor about how to prepare and whether you will have to stay in the hospital overnight.

If you are to be sedated, you may be asked not to eat or drink anything for up to eight hours before your exam. Leave jewelry at home and wear loose, comfortable clothing.

What should I expect during my vascular and intravascular ultrasound?

You will be positioned on the procedure table.

You may be connected to monitors that track your heart rate, blood pressure, oxygen level, and pulse.

A nurse or technician will insert an intravenous (IV) line into a vein in your hand or arm to administer a sedative. Some patients may require general anesthesia.

Your physician will numb the area with a local anesthetic. This may briefly burn or sting before the area becomes numb.

A very small skin incision is made at the site.

A sheath is first inserted into an artery or vein (usually in the groin). Using x-ray or ultrasound guidance, the catheter is inserted into the sheath and gently maneuvered through the vessel to the target location.

Once in place, the transducer on the end of the catheter uses sound waves to produce pictures of the blood vessels. Doctors can move the catheter to obtain images at different locations.

You may need to lie flat on your back for a few hours after the test with pressure applied to the catheter insertion site in your groin to prevent bleeding. In some cases, your physician may use a device that seals the small hole in the artery, called a "closure device," which will allow you to move around sooner.

Your catheter site will be checked for bleeding or swelling for several hours, and your blood pressure and heart rate will be monitored.

Your time in the hospital will vary depending on what procedure was done with IVUS. Catheter angiography recovery will require you to stay in the hospital for observation for up to six hours. Angioplasty and vascular stenting may require 12 to 24 hours. Recovery time depends on how complex your procedure was.

Some patients may be kept overnight in the hospital for observation. You will not be allowed to drive yourself home from the hospital.

After you return home, you should rest and drink plenty of fluids. Avoid lifting heavy objects and strenuous exercise for at least 24 hours, sometimes longer.

Call your physician immediately if you notice any change in your leg's color, pain, swelling, or warm feeling in the area where the catheter was inserted.

Why choose Presbyterian for vascular and intravascular ultrasound?

Presbyterian Heart and Vascular Care has a skilled vascular care team who can provide a wide range of services from diagnosis to treatment. Their surgeons are trained in many different techniques and procedures, many of which can provide you with a shorter recovery period and less hospital time.