IVUS Use in Peripheral Vascular Disease: Should this Tool Be Used More Frequently in Peripheral Interventions?

Use of intravascular ultrasound (IVUS) has increased rapidly, and several randomized and observational studies have shown improved results in patients who underwent coronary angioplasty using this tool.

¿Es frecuente el uso de IVUS para guiar la ATC?

However, evidence on IVUS on peripheral interventions is more limited. Observational studies have found similar benefits when IVUS was part of the revascularization strategy. In a meta-analysis of eight observational studies, IVUS use had similar results in terms of patency and re-intervention compared with angiography alone but was linked to a lower rate of peri-procedural adverse events and vascular complications.

The aim of this retrospective study was to evaluate the trend, the variation, and the results of IVUS use during peripheral interventions among patients with health insurance.

The primary endpoint (PEP) was major adverse limb-related events (MALE), defined as a composite of acute lower-limb ischemia (thrombosis/embolism) or major limb amputation. The secondary endpoint (SEP) included minor amputation (defined as forefoot or finger joint amputation).

The study included a total of 543,488 patients who underwent peripheral intervention, of whom 11.7% used IVUS. There was an increase in IVUS use. Mean patient age was 76 years old, and most subjects were male. Femoropopliteal disease was the most frequent type. The most frequent clinical presentation was intermittent claudication, followed by critical lower-limb ischemia.

In terms of the PEP, IVUS use significantly decreased the MALE index (p < 0.0001), lower-limb acute ischemia (p < 0.0001), and major amputation (p < 0.0001). When analyzing the SEP results, minor amputation (p < 0.0001) or any amputation (p < 0.0001) rates were also lower when using IVUS.

Conclusion

According to data provided by this study, IVUS use has increased in peripheral interventions since 2016. When used as a therapeutic strategy, there has been an improvement in results—including MALE rates. Prospective studies are needed to confirm IVUS usefulness and to detect the specific clinical scenarios where it can be used in the decision-making process.