Overcoming the diagnostic challenges in deep venous obstruction: the imperative integration of morphological and hemodynamic testing in clinical practice

Deep vein obstruction (DVO) in the lower limbs stems from a range of underlying causes, encompassing both thrombotic and nonthrombotic origins. In some cases, preexisting nonthrombotic obstructions may evolve into thrombotic ones, a phenomenon exemplified in rare conditions like iliac vein compression aplasia or hypoplasia. The complex nature of DVO leads to differences in its clinical presentation and hemodynamic impact. The diverse clinical manifestations of DVO, ranging from asymptomatic cases to venous ulcers, may present challenges in the evaluation of this condition. In this article, we address limitations of common diagnostic methods such as ultrasound, intravascular ultrasound, venography, computed tomography venography, and magnetic resonance venography for DVO. Furthermore, we emphasize the need for a combined morphological and hemodynamic testing approach, as relying solely on one method often provides an incomplete picture of the obstruction's nature and symptom severity. Morphological testing focuses on visualizing the physical structure of the veins to identify any obstructions using factors such as stenosis, occlusions, collaterals, etc. Hemodynamic testing, on the other hand, examines the functional aspects of blood flow within the affected veins, providing information on blood pressure, velocity, and flow characteristics. By combining the 2 assessments, we can use an integrated approach to enhance diagnostic accuracy and develop personalized and efficacious treatment plans.