Objetivo: Avaliar se a administração sistêmica de cilostazol reduz a hiperplasia neointimal nas artérias ilíacas de suínos submetidas a angioplastia com cateter balão. Métodos: O trabalho foi desenvolvido na Unidade de Experimentação Animal do Hospital de Clínicas de Porto Alegre. Vinte suínos foram submetidos a angioplastia com cateter balão 6 x 40 mm na artéria ilíaca comum direita, guiada por ultrassonografia com Doppler. Os animais foram randomizados em dois grupos: grupo 1 (n = 10), no qual foi administrado cilostazol 50 mg em duas doses diárias, e grupo 2 (n = 10), considerado controle. Após 30 dias, os animais foram sacrificados, e as artérias ilíacas preparadas para análise histológica. Os cortes histológicos foram digitalizados e analisados por morfometria digital. A análise estatística foi realizada com o teste t de Student e o de Mann-Whitney. Resultados: Comparando as artérias ilíacas submetidas a angioplastia com as não submetidas a angioplastia, houve hiperplasia neointimal significativa (0,228 versus 0,119 mm2; p = 0,0001). Nas artérias submetidas a angioplastia, não houve diferença entre o grupo 1 (cilostazol) e o grupo 2 (controle) na área do lúmen (2,277 versus 2,575 mm2; p = 0,08), área da íntima (0,219 versus 0,237 mm2; p = 0,64), área da média (2,262 versus 2,393 mm2; p = 0,53) e no percentual de obstrução neointimal (8,857 versus 9,257 %; p = 0,82). Conclusão: O uso de cilostazol 50 mg em duas doses diárias não reduziu a hiperplasia neointimal em artérias ilíacas de suínos submetidas a angioplastia com cateter balão. / Objective: To evaluate whether systemic administration of cilostazol reduces neointimal hyperplasia in the iliac arteries of pigs after balloon angioplasty. Methods: This study was conducted in the Experimental Animal Unit of Hospital de Clínicas de Porto Alegre, Brazil. Twenty pigs underwent angioplasty of the right common iliac artery under Doppler ultrasound guidance using 6x40-mm balloon catheters. The animals were randomized to one of two groups: group 1 (n = 10) received 50 mg cilostazol in two doses a day; and group 2 (n = 10) was the control group. After 30 days, the animals were killed and their iliac arteries were prepared for histological analysis. Histological images were digitalized and analyzed using digital morphometry. The Student t and the Mann-Whitney tests were used for statistical analyses. Results: Iliac arteries that underwent angioplasty had significantly more neointimal hyperplasia than those with no angioplasty (0.228 versus 0.119 mm2; p = 0.0001) Group 1 (cilostazol) and 2 (control) had no significant differences in lumen (2.277 versus 2.575 mm2; p = 0.08), intima (0.219 versus 0.237 mm2; p = 0.64) or media (2.262 versus 2.393 mm2; p = 0.53) area, or in percentage of neointimal obstruction (8.857 versus 9.257 %; p = 0.82). Conclusion: The use of 50 mg cilostazol in two doses a day did not reduce neointimal hyperplasia in iliac arteries of pigs that underwent balloon angioplasty.

Objetivo: Avaliar se a administração sistêmica de cilostazol reduz a hiperplasia neointimal nas artérias ilíacas de suínos submetidas a angioplastia com cateter balão. Métodos: O trabalho foi desenvolvido na Unidade de Experimentação Animal do Hospital de Clínicas de Porto Alegre. Vinte suínos foram submetidos a angioplastia com cateter balão 6 x 40 mm na artéria ilíaca comum direita, guiada por ultrassonografia com Doppler. Os animais foram randomizados em dois grupos: grupo 1 (n = 10), no qual foi administrado cilostazol 50 mg em duas doses diárias, e grupo 2 (n = 10), considerado controle. Após 30 dias, os animais foram sacrificados, e as artérias ilíacas preparadas para análise histológica. Os cortes histológicos foram digitalizados e analisados por morfometria digital. A análise estatística foi realizada com o teste t de Student e o de Mann-Whitney. Resultados: Comparando as artérias ilíacas submetidas a angioplastia com as não submetidas a angioplastia, houve hiperplasia neointimal significativa (0,228 versus 0,119 mm2; p = 0,0001). Nas artérias submetidas a angioplastia, não houve diferença entre o grupo 1 (cilostazol) e o grupo 2 (controle) na área do lúmen (2,277 versus 2,575 mm2; p = 0,08), área da íntima (0,219 versus 0,237 mm2; p = 0,64), área da média (2,262 versus 2,393 mm2; p = 0,53) e no percentual de obstrução neointimal (8,857 versus 9,257 %; p = 0,82). Conclusão: O uso de cilostazol 50 mg em duas doses diárias não reduziu a hiperplasia neointimal em artérias ilíacas de suínos submetidas a angioplastia com cateter balão. / Objective: To evaluate whether systemic administration of cilostazol reduces neointimal hyperplasia in the iliac arteries of pigs after balloon angioplasty. Methods: This study was conducted in the Experimental Animal Unit of Hospital de Clínicas de Porto Alegre, Brazil. Twenty pigs underwent angioplasty of the right common iliac artery under Doppler ultrasound guidance using 6x40-mm balloon catheters. The animals were randomized to one of two groups: group 1 (n = 10) received 50 mg cilostazol in two doses a day; and group 2 (n = 10) was the control group. After 30 days, the animals were killed and their iliac arteries were prepared for histological analysis. Histological images were digitalized and analyzed using digital morphometry. The Student t and the Mann-Whitney tests were used for statistical analyses. Results: Iliac arteries that underwent angioplasty had significantly more neointimal hyperplasia than those with no angioplasty (0.228 versus 0.119 mm2; p = 0.0001) Group 1 (cilostazol) and 2 (control) had no significant differences in lumen (2.277 versus 2.575 mm2; p = 0.08), intima (0.219 versus 0.237 mm2; p = 0.64) or media (2.262 versus 2.393 mm2; p = 0.53) area, or in percentage of neointimal obstruction (8.857 versus 9.257 %; p = 0.82). Conclusion: The use of 50 mg cilostazol in two doses a day did not reduce neointimal hyperplasia in iliac arteries of pigs that underwent balloon angioplasty.

No description available.

The goal of this project was to determine whether i) fused deposition modeling could be employed to manufacture molds for vascular constructs, ii) whether vascular constructs could be created from these molds, and iii) to verify practical equivalence between observed fluid velocities. Dye tracking was to be employed to characterize fluid velocity profiles through the in vitro vascular constructs, including a half-vessel model and a full vessel model of an iliac artery aneurysm. A PDMS half-vessel construct was manufactured, and the movement of dye through the construct was tracked by a cellphone camera. Thresholds were applied to each video in HSB or YUV mode in ImageJ, and analyzed to determine the velocity of the fluid through the construct. COMSOL simulations of the half-vessel were conducted for comparison to the empirical observations. Plots describing the flow velocities along the maximum streamline path length were generated, and a one sample t-test was conducted at a 5% significance level to determine whether there was a significant difference between velocity values obtained by dye tracking and the COMSOL simulations. It was determined that the empirical dye tracking trials failed to demonstrate agreement between the measured and predicted flow rates. A full vessel construct was not completed due to unforeseen time constraints. Dye tracking was not determined to be reliable as a means of measuring the maximum velocity of fluid. Discrepancies between the empirical observations and the COMSOL simulation are discussed. The discrepancy was attributed to limitations in the experimental protocol; low frame rate, poor control over lighting conditions, and the subjectivity involved in image processing. Methods of improving upon the manufacturing and experimental protocols used for the half-vessel are proposed for future work, such as improving control over lighting conditions, choosing a camera with a higher frame rate, constructing a more stable fixture, exploring PIV. Additionally, the technical problems leading to the failure to complete the full vessel model are discussed, and changes in the manufacturing process are proposed to allow dissolution or removal of the aneurysm model.

<p>In contrast-enhanced magnetic resonance angiography (CE-MRA),vascular signal is produced by the acquisition of a T1-weighted magnetic resonance imaging scan while the presence of a contrast agent induces a low T1 in blood. In this thesis,CE-MRA of the aortoiliac arteries was evaluated.Different contrast agents and techniques for synchronisation of the scan with the contrast bolus passage were assessed.</p><p>In 30 patients with clinically suspected iliac artery stenoses,contrast-enhanced magnetic resonance angiography was compared with duplex ultrasound scanning and digital subtraction x-ray angiography (DSA),with intraarterial pressure measurements as reference method. No statistically significant differences in sensitivity or specificity were observed between the techniques regarding the detection of hemodynamically significant iliac stenoses. The use of multiplanar reformats and source images in the MRA examinations was of value for the differentiation between high-grade stenoses and occlusions. With DSA as reference method, MRA had significantly higher sensitivity and specificity than duplex for the detection of ≥50% stenoses.</p><p>In fourteen patients examined with iliac artery MRA, differences in contrast arrival time of up to 7 s was observed between the aorta and the common femoral artery.A dual-station timing technique adjusting for this difference was found feasible. Compared with a fluoroscopically triggered technique (n=13),which is used in clinical rotine, the dual-station technique was more reliable for the visualisation of distal vessels.</p><p>In a clinical phase II study comparing different doses of t he contrast agent gadobenate dimeglumine for the enhancement of iliac artery MRA, a significant improvement in subjective diagnostic quality compared with time-of-flight MRA was found at all doses from 0.025 mmol/kg.An increasing trend with dose was observed up to a dose level of 0.05-0.1 mmol/kg.</p><p>In a phase I clinical study on the intravascular, iron oxide contrast agent NC100150 Injection, a positive dose response was observed for abdominal vascular enhancement, with the highest contrast-to-noise ratio observed at 4.0 mg Fe/kg bw at 1.5 T and at 2.5-4 mg Fe/kg bw at 0.5 T.At 1.5 T higher R2*values were calculated for the aorta than for the IVC.</p>

In contrast-enhanced magnetic resonance angiography (CE-MRA),vascular signal is produced by the acquisition of a T1-weighted magnetic resonance imaging scan while the presence of a contrast agent induces a low T1 in blood. In this thesis,CE-MRA of the aortoiliac arteries was evaluated.Different contrast agents and techniques for synchronisation of the scan with the contrast bolus passage were assessed. In 30 patients with clinically suspected iliac artery stenoses,contrast-enhanced magnetic resonance angiography was compared with duplex ultrasound scanning and digital subtraction x-ray angiography (DSA),with intraarterial pressure measurements as reference method. No statistically significant differences in sensitivity or specificity were observed between the techniques regarding the detection of hemodynamically significant iliac stenoses. The use of multiplanar reformats and source images in the MRA examinations was of value for the differentiation between high-grade stenoses and occlusions. With DSA as reference method, MRA had significantly higher sensitivity and specificity than duplex for the detection of ≥50% stenoses. In fourteen patients examined with iliac artery MRA, differences in contrast arrival time of up to 7 s was observed between the aorta and the common femoral artery.A dual-station timing technique adjusting for this difference was found feasible. Compared with a fluoroscopically triggered technique (n=13),which is used in clinical rotine, the dual-station technique was more reliable for the visualisation of distal vessels. In a clinical phase II study comparing different doses of t he contrast agent gadobenate dimeglumine for the enhancement of iliac artery MRA, a significant improvement in subjective diagnostic quality compared with time-of-flight MRA was found at all doses from 0.025 mmol/kg.An increasing trend with dose was observed up to a dose level of 0.05-0.1 mmol/kg. In a phase I clinical study on the intravascular, iron oxide contrast agent NC100150 Injection, a positive dose response was observed for abdominal vascular enhancement, with the highest contrast-to-noise ratio observed at 4.0 mg Fe/kg bw at 1.5 T and at 2.5-4 mg Fe/kg bw at 0.5 T.At 1.5 T higher R2*values were calculated for the aorta than for the IVC.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Approximately 25% of all fractures in dogs involve the pelvis, of which 18-46% are iliac fractures. Conservative treatment can be performed in simple cases where minimum displacement occurs fractured fragments. However when there is severe displacement of the fragments, pelvic canal narrowing and involvement of weight bearing, surgical fixation is indicated. A variety of techniques have been described for the iliac fracture fixation. The highest percentage of successful cases can be attributed to the use of plates. Other methods used include pins, cerclage wire and compression screw. This study evaluated biomechanically the use of cortical allografts preserved in honey for the stabilization of transverse osteotomy of the ilium in dogs, as well as the use of hemicerclage wire isolated this cases, and compared the of two methods against the forces of bending. Were prepared cortical bone implants removed from humerus of dogs that eventually died for reasons not related to this research. The implants were preserved in honey for a period between 30 and 128 days. Were tested bilaterally thirteen canines pelves which held the body transverse osteotomy of the ilium. One hemipelvis of each dog was stabilized with a bone graft fixed by two hemicerclage wire and the contralateral hemipelvis with hemicerclage wire alone. To test the strength of flexion was used a manual compression machine where hemipelvis each was mounted on a wooden support. It was established that the time to stop the application of bending force would be when the fissure of the fracture suffer traction until half the width of the ilium (TMLI) or to failure. The strength of flexion needed to TMLI was significantly higher (P = 0.03) for hemipelves stabilized with bone implants (mean ± SD: 16.54 ± 5.29 kg) than for hemipelves stabilized with hemicerclage wire used alone (mean ± SD: 12.54 ± 4.01 kg). The force applied to fail was also statistically higher (P = 0.002) for hemipelves stabilized with bone implants (mean ± SD: 20.16 ± 7.3 kg) than in stabilized with hemicerclage wire used alone (mean ± SD: 12.54 ± 4.01 kg). The results showed that the use of cortical bone implants is a viable alternative for fixing the iliac osteotomy and is more resistant to strength of flexion in relation to the use of hemicerclage wire used in isolation. / Aproximadamente 25% de todas as fraturas em cães envolvem a pelve, sendo que 18-46% são fraturas ilíacas. O tratamento conservador pode ser realizado em casos simples onde ocorre deslocamento mínimo dos fragmentos fraturados. Entretanto, quando há deslocamento grave dos fragmentos, estreitamento do canal pélvico e comprometimento do suporte de peso, a fixação cirúrgica é indicada. Uma variedade de técnicas tem sido descrita para a fixação de fraturas ilíacas. A maior porcentagem de casos de sucesso pode ser atribuída ao uso de placas. Outros métodos usados incluem pinos, cerclagem de fio de aço e parafusos compressivos. Este trabalho avaliou biomecanicamente o uso de um implante ósseo cortical alógeno preservado em mel para a estabilização de osteotomia transversa de ílio em cães, bem como o uso de hemicerclagem de fio de aço isoladamente nestes casos, e comparou os dois métodos de estabilização de ílio frente às forças de flexão. Foram confeccionados implantes ósseos corticais alógenos retirados de úmeros de cães que vieram a óbito por motivos não relacionados com este trabalho. Os implantes foram preservados em mel por um período entre 30 e 128 dias. Foram testadas bilateralmente 13 pelves caninas nas quais se realizou osteotomia transversa do corpo do ílio. Uma hemipelve de cada cão foi estabilizada com o implante ósseo fixado por meio de duas hemicerclagens de fio de aço e a hemipelve contralateral com hemicerclagem de fio de aço isoladamente. Para testar a força de flexão, foi utilizada uma prensa de compressão manual onde cada hemipelve foi montada em um suporte de madeira. Foi estabelecido que o momento de interromper a aplicação da força de flexão seria quando a fenda da fratura sofresse tração até a metade da largura do ílio (TMLI) ou até a falha. A força de flexão necessária para TMLI foi significativamente maior (P=0,03) para hemipelves estabilizadas com implante ósseo (média ± SD: 16,54 ± 5,29 kgf) do que para as hemipelves estabilizadas com hemicerclagem de fio de aço usada isoladamente (média ± SD: 12,54 ± 4,01 kgf). A força aplicada para falhar também foi estatisticamente maior (P= 0,002) para as hemipelves estabilizadas com implante ósseo (média ± SD: 20,16 ± 7,3 kgf) do que nas estabilizadas com hemicerclagem de fio de aço usada isoladamente (média ± SD: 12,54 ± 4,01 kgf). Os resultados demonstraram que o uso de implante ósseo cortical alógeno é uma alternativa viável para a fixação da osteotomia ilíaca e apresenta maior resistência à força de flexão em relação ao uso de hemicerclagem de fio de aço usada isoladamente.

This master thesis analyses stress and strain of iliac artery with atheroma. Model of artery is created as 2D and symmetric about the y-axis. The first part of the thesis deals with a research, which includes obtaining information from medicine, which is necessary fort the right solution of the task. Next part dedicates to nonlinear mechanics, constitutive modeling from the view of biomechanice and computational modeling of arteries. In the next part is made analysis for load on artery by physiological and also by high blood pressure. In the end were specified uncertainties of the used model and evaluated chance of atherosclerotic plaque rupture.

Introdução: O tratamento da Insuficiência Venosa Crônica (IVC) é baseado na correção dos refluxos e obstruções ao fluxo sanguíneo venoso. A detecção, a gravidade e o tratamento dessas obstruções venosas, responsáveis pelos sinais e sintomas da IVC, têm sido recentemente estudados e melhor compreendidos. Estes estudos não definem qual o grau de obstrução significativa nem os critérios ultrassonográficos para sua detecção. O objetivo deste estudo foi determinar critérios ultrassonográficos para o diagnóstico das obstruções venosas ilíacas, avaliando a concordância deste método com o ultrassom intravascular (UI) em pacientes portadores de IVC avançada. Métodos: Foram avaliados 15 pacientes (30 membros; 49,4 ± 10,7 anos; 1 homem) com IVC inicial (Classificação Clínica-Etiológica-Anatômica-Physiopatológica - CEAP C1-2) no grupo I (GI) e 51 pacientes (102 membros; 50,53 ± 14,5 anos; 6 homens) com IVC avançada (CEAP C3-6) no grupo II (GII) pareados por sexo, idade e etnia. Todos pacientes foram submetidos à entrevista clínica e à ultrassonografia vascular com Doppler (UV-D), sendo obtidas as medidas de fasicidade de fluxo, os índices de fluxo e velocidades venosas femorais, e as relações de velocidade e de diâmetro da obstrução ilíaca. Foi analisado o escore de refluxo multisegmentar. Os indivíduos do GI foram avaliados por 3 examinadores independentes. Os pacientes do GII foram submetidos ao UI, sendo obtidos a área dos segmentos venosos comprometidos e comparados com os resultados obtidos pelo UV-D, agrupados em 3 categorias: obstruções < 50%; obstruções entre 50-79% e obstruções >= 80%. Resultados: A classe de severidade clinica CEAP predominante no GI foi C1 em 24/30 (80%) membros, e C3 em 54/102 (52,9%) membros no GII. O refluxo foi severo (escore de refluxo multisegmentar >= 3) em 3/30 (10%) membros no grupo I, e em 45/102 (44,1%) membros no grupo II (p<0,001). Houve uma concordância moderadamente elevada entre o UV-D e o UI, quando agrupadas em 3 categorias (K=0,598; p<0,001), e uma concordância elevada quando agrupadas em 2 categorias (obstruções <50% e >= 50%) (K= 0,784; p<0,001). Os melhores pontos de corte e sua correlação com o UI foram: índice de velocidade (0,9; r=-0,634; p<0,001); índice de fluxo (0,7; r=-0,623; p<0,001); relação de obstrução (0,5; r=0,750; p<0,001); relação de velocidade (2,5; r= 0,790; p<0,001); A ausência de fasicidade de fluxo esteve presente em 88,2% dos pacientes com obstrução >=80% ao UV-D. Foi construído um algoritmo ultrassonográfico vascular, utilizando as medidas e os pontos de corte descritos obtendo-se uma acurácia de 79,6% para 3 categorias (K=0,655; p<0,001) e de 86,7% para 2 categorias (k=0,730; p<0,001). Conclusões: O UV-D apresentou uma concordância elevada com o UI na detecção de obstruções >= 50%. A relação de velocidade na obstrução >= 2,5 é o melhor critério para detecção de obstruções venosas significativas em veias ilíacas. / Introduction: The treatment of Chronic Venous Insufficiency (CVI) is based on correction of reflux and obstruction of venous blood flow. The detection, severity and treatment of venous obstructions, responsible for signs and symptoms of CVI have been recently studied and better understood. These studies did not define the degree of significant obstruction or the sonographic criteria for its detection. The purpose of this study was to determine the sonographic criteria for diagnosis of iliac venous outflow obstruction by assessing the correlation of this method with intravascular ultrasound (IVUS) in patients with advanced chronic venous insufficiency (CVI). Methods: The evaluation included 15 patients (30 limbs, age 49.4 ± 10.7 years; 1 man) with initial CVI symptoms (Clinical-Etiology-Anatomy-Pathophysiology classification - CEAP C1-2) in group I (GI) and 51 patients (102 limbs, 50.53 ± 14.5 years, 6 men) with advanced CVI symptoms (CEAP C3-6) in group II (GII). Patients from both groups were matched by gender, age and ethnicity. All patients underwent a clinic interviews and Duplex Ultrasound (DU), measuring the flow phasicity, the femoral volume flows and velocities, and the velocities and obstructions ratios in the iliac vein. The Reflux Multisegment Score were analyzed. Three independent observers evaluated individuals in GI. GII patients were submitted to IVUS, in which the area of the impaired venous segments was obtained and compared to the DU results, and then grouped into 3 categories: obstructions < 50%; obstructions between 50 and 79% and obstructions >= 80%. Results: The predominant clinical severity CEAP class was C1 in 24/30 (80%) limbs in GI and C3 in 54/102 (52.9%) limbs in GII. Reflux was severe (reflux multisegment score >= 3) in 3/30 (10%) limbs in GI and 45/102 (44.1%) limbs in GII (p<0.001). There was a moderately high agreement between DU and IVUS findings when grouped into 3 categories (k= 0.598; p<0.001), and high agreement when grouped into 2 categories (obstructions <50% and >= 50%) (k=0.784; p<0.001). The best cut-off points and their correlation with IVUS were 0.9 for the velocity index (r =-0.634; p< 0.001); 0.7 for the flow index (r=-0.623; p<0.001); 0.5 for the obstruction ratio (r=0.750; p<0.001), and 2.5 for the velocity ratio (r=0.790; p<0.001). Absence of flow phasicity was observed in 62.5% of patients with obstructions >= 80%. An ultrasound algorithm was created using the measures and the described cut-off points with accuracy of 86.7% for detecting significant obstructions (>= 50%) with high agreement (k=0.73; p< 0.001). Conclusions: DU presented high agreement with IVUS for detection of obstructions >= 50%. The velocity ratio in obstructions >= 2.5 is the best criteria for detection of significant venous outflow obstructions in iliac veins.

Introdução: O tratamento da Insuficiência Venosa Crônica (IVC) é baseado na correção dos refluxos e obstruções ao fluxo sanguíneo venoso. A detecção, a gravidade e o tratamento dessas obstruções venosas, responsáveis pelos sinais e sintomas da IVC, têm sido recentemente estudados e melhor compreendidos. Estes estudos não definem qual o grau de obstrução significativa nem os critérios ultrassonográficos para sua detecção. O objetivo deste estudo foi determinar critérios ultrassonográficos para o diagnóstico das obstruções venosas ilíacas, avaliando a concordância deste método com o ultrassom intravascular (UI) em pacientes portadores de IVC avançada. Métodos: Foram avaliados 15 pacientes (30 membros; 49,4 ± 10,7 anos; 1 homem) com IVC inicial (Classificação Clínica-Etiológica-Anatômica-Physiopatológica - CEAP C1-2) no grupo I (GI) e 51 pacientes (102 membros; 50,53 ± 14,5 anos; 6 homens) com IVC avançada (CEAP C3-6) no grupo II (GII) pareados por sexo, idade e etnia. Todos pacientes foram submetidos à entrevista clínica e à ultrassonografia vascular com Doppler (UV-D), sendo obtidas as medidas de fasicidade de fluxo, os índices de fluxo e velocidades venosas femorais, e as relações de velocidade e de diâmetro da obstrução ilíaca. Foi analisado o escore de refluxo multisegmentar. Os indivíduos do GI foram avaliados por 3 examinadores independentes. Os pacientes do GII foram submetidos ao UI, sendo obtidos a área dos segmentos venosos comprometidos e comparados com os resultados obtidos pelo UV-D, agrupados em 3 categorias: obstruções < 50%; obstruções entre 50-79% e obstruções >= 80%. Resultados: A classe de severidade clinica CEAP predominante no GI foi C1 em 24/30 (80%) membros, e C3 em 54/102 (52,9%) membros no GII. O refluxo foi severo (escore de refluxo multisegmentar >= 3) em 3/30 (10%) membros no grupo I, e em 45/102 (44,1%) membros no grupo II (p<0,001). Houve uma concordância moderadamente elevada entre o UV-D e o UI, quando agrupadas em 3 categorias (K=0,598; p<0,001), e uma concordância elevada quando agrupadas em 2 categorias (obstruções <50% e >= 50%) (K= 0,784; p<0,001). Os melhores pontos de corte e sua correlação com o UI foram: índice de velocidade (0,9; r=-0,634; p<0,001); índice de fluxo (0,7; r=-0,623; p<0,001); relação de obstrução (0,5; r=0,750; p<0,001); relação de velocidade (2,5; r= 0,790; p<0,001); A ausência de fasicidade de fluxo esteve presente em 88,2% dos pacientes com obstrução >=80% ao UV-D. Foi construído um algoritmo ultrassonográfico vascular, utilizando as medidas e os pontos de corte descritos obtendo-se uma acurácia de 79,6% para 3 categorias (K=0,655; p<0,001) e de 86,7% para 2 categorias (k=0,730; p<0,001). Conclusões: O UV-D apresentou uma concordância elevada com o UI na detecção de obstruções >= 50%. A relação de velocidade na obstrução >= 2,5 é o melhor critério para detecção de obstruções venosas significativas em veias ilíacas. / Introduction: The treatment of Chronic Venous Insufficiency (CVI) is based on correction of reflux and obstruction of venous blood flow. The detection, severity and treatment of venous obstructions, responsible for signs and symptoms of CVI have been recently studied and better understood. These studies did not define the degree of significant obstruction or the sonographic criteria for its detection. The purpose of this study was to determine the sonographic criteria for diagnosis of iliac venous outflow obstruction by assessing the correlation of this method with intravascular ultrasound (IVUS) in patients with advanced chronic venous insufficiency (CVI). Methods: The evaluation included 15 patients (30 limbs, age 49.4 ± 10.7 years; 1 man) with initial CVI symptoms (Clinical-Etiology-Anatomy-Pathophysiology classification - CEAP C1-2) in group I (GI) and 51 patients (102 limbs, 50.53 ± 14.5 years, 6 men) with advanced CVI symptoms (CEAP C3-6) in group II (GII). Patients from both groups were matched by gender, age and ethnicity. All patients underwent a clinic interviews and Duplex Ultrasound (DU), measuring the flow phasicity, the femoral volume flows and velocities, and the velocities and obstructions ratios in the iliac vein. The Reflux Multisegment Score were analyzed. Three independent observers evaluated individuals in GI. GII patients were submitted to IVUS, in which the area of the impaired venous segments was obtained and compared to the DU results, and then grouped into 3 categories: obstructions < 50%; obstructions between 50 and 79% and obstructions >= 80%. Results: The predominant clinical severity CEAP class was C1 in 24/30 (80%) limbs in GI and C3 in 54/102 (52.9%) limbs in GII. Reflux was severe (reflux multisegment score >= 3) in 3/30 (10%) limbs in GI and 45/102 (44.1%) limbs in GII (p<0.001). There was a moderately high agreement between DU and IVUS findings when grouped into 3 categories (k= 0.598; p<0.001), and high agreement when grouped into 2 categories (obstructions <50% and >= 50%) (k=0.784; p<0.001). The best cut-off points and their correlation with IVUS were 0.9 for the velocity index (r =-0.634; p< 0.001); 0.7 for the flow index (r=-0.623; p<0.001); 0.5 for the obstruction ratio (r=0.750; p<0.001), and 2.5 for the velocity ratio (r=0.790; p<0.001). Absence of flow phasicity was observed in 62.5% of patients with obstructions >= 80%. An ultrasound algorithm was created using the measures and the described cut-off points with accuracy of 86.7% for detecting significant obstructions (>= 50%) with high agreement (k=0.73; p< 0.001). Conclusions: DU presented high agreement with IVUS for detection of obstructions >= 50%. The velocity ratio in obstructions >= 2.5 is the best criteria for detection of significant venous outflow obstructions in iliac veins.