Intravascular ultrasound useful in arterial and venous lower extremity interventions: JACC
USA: A new international consensus document has stated that the use of intravascular ultrasound (IVUS) imaging can guide operators in a variety of clinical scenarios involving lower-extremity arterial and venous interventions. The article appears in JACC: Cardiovascular Interventions.
During lower extremity arterial and venous revascularization, there has been a growing use of IVUS. Observational data have shown that IVUS use can improve periprocedural and long-term outcomes but there is a dearth of largescale prospective data. Hence, there arises a need for the appropriate use of IVUS during the peripheral intervention.
Acknowledging the gap in high-quality data, Eric A. Secemsky, Harvard Medical School, Boston, Massachusetts, USA, and colleagues aimed to provide guidance on the appropriate use of IVUS in various phases of peripheral arterial and venous interventions in a consensus document.
For this purpose, a 12-member writing committee was convened to derive consensus regarding the appropriate clinical scenarios for peripheral IVUS use. A 72-question survey representing 12 lower extremity arterial interventional scenarios was iteratively created by the group. A 40-question survey representing 8 iliofemoral venous interventional scenarios was separately constructed.
Clinical scenarios were categorized by interventional phases: preintervention, intraprocedural, and postintervention optimization. The survey instrument was completed by thirty international vascular experts (15 for each survey). Using the median value and disseminated to the voting panel to reevaluate for any disagreement, results were categorized by appropriateness.
Key findings were as follows:
- Consensus opinion concluded that IVUS use may be appropriate during the preintervention phase for evaluating the etiology of vessel occlusion and plaque morphology in the iliac and femoropopliteal arteries.
- IVUS was otherwise rated as appropriate during iliac and femoropopliteal revascularization in most other preintervention scenarios, as well as intraprocedural and postprocedural optimization phases.
- IVUS was rated appropriate in all interventional phases for the tibial arteries.
- For iliofemoral venous interventions, IVUS was rated as appropriate in all interventional phases.
"Expert consensus can help define clinical procedural scenarios in which peripheral IVUS may have value during lower extremity arterial and venous intervention while additional prospective data are collected," the researchers concluded.
Reference:
Secemsky EA, Mosarla RC, Rosenfield K, Kohi M, Lichtenberg M, Meissner M, Varcoe R, Holden A, Jaff MR, Chalyan D, Clair D, Hawkins BM, Parikh SA. Appropriate Use of Intravascular Ultrasound During Arterial and Venous Lower Extremity Interventions. JACC Cardiovasc Interv. 2022 Aug 8;15(15):1558-1568. doi: 10.1016/j.jcin.2022.04.034. PMID: 35926922.
