Peripheral vascular disease is on the rise and peripheral PCI is at present the first choice of treatment for most patients.
The use of IVUS in femoropopliteal territory has shown great benefits, especially in left main and complex PCI, reducing mortality and restenosis but, though promising, in lower limb ischemia we have little information as regards outcomes.
The study looked at 85649 patients undergoing PCI in Japan. 50925 (59.5%) were done using IVUS.
Primary end point was major or minor amputation at 12 months after procedure.
Mean age was 74 and over 70% were men. Patients receiving IVUS presented more comorbidities, dementia, interactions and received more devices (stents, DEB, and atherotome); therefore, patients were match with propensity score, which left 31534 patients in each group.
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Primary end point resulted in favor of the IVUS group (6.9% vs. 9.3%HR, 0.80 [95% CI, 0.72–0.89] p<0.001). Also, this populations presented lower need for CABG (2.5% vs. 4.9% HR, 0.51[95% CI, 0.44–0.60] p<0.001) and stent graft vs. Non-IVUS patients, while they did present more reintervention and readmission with no difference in mortality.
Total hospitalization cost was lower with IVUS.
Conclusion
In this retrospective study, IVUS guided peripheral PCI was associated to lower amputation risk vs. peripheral PCI not guided by IVUS. These data should be interpreted with caution given its limitations as an observational study. Further research is required for researchers to be able to confirm the use of IVUS will lead to lower amputation rates.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: Amputation After Endovascular Therapy With and Without Intravascular Ultrasound Guidance: A Nationwide Propensity Score–Matched Study.
Reference: Nao Setogawa, et al. Circ Cardiovasc Interv. 2023;16:e012451. DOI: 10.1161/CIRCINTERVENTIONS.122.012451.
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