Endovascular therapy in intermittent claudication: Impact of IVUS guidance on treatment decisions

Background and Aims Conservative therapy is favored over revascularization for patients with peripheral arterial disease (PAD) and intermittent claudication (IC) owing to the better long-term results. The adjunctive use of intravascular ultrasound (IVUS) significantly improves endovascular therapy. However, data on IVUS and IC is scarce. Therefore, the aim of this investigation was to determine the safety and efficacy of IVUS in patients with IC and to evaluate discrepancies compared to angiography and potential consequences for treatment. Methods This was a single-center prospective cohort study. Twenty patients with IC and femoropopliteal disease eligible for endovascular therapy were enrolled. Procedural data and discrepancies between IVUS and angiography were recorded. Results In total, 30 lesions were treated. IVUS-based measurements yielded substantially higher reference vessel diameters (RVD) and lesion lengths compared to DSA alone (RVD: 5.37 +/- 0.71 mm vs. 4.74 +/- 0.63 mm, p<.001, lesion length: 62.4 +/- 41.4 mm vs. 42.18 +/- 30.2 mm, p<.001). In 24 of 30 lesions (80%), a significant discrepancy in RVD (defined as difference >0.5 mm) and lesion length (defined as >20 mm) was determined between IVUS and standard DSA. Subsequently, IVUS assessment led to upsizing in 14 of 30 lesions (47%) and downsizing in 3 of 30 lesions (10%). On average, IVUS led to the selection of considerably larger balloons (5.25 +/- 0.62 vs. 4.74 +/- 0.63, p<.004) and device length (78.97 +/- 44.19 mm vs. 42.18 +/- 30.2, p<.001). Serious adverse events did not occur. Technical success was achieved in all cases. Conclusion IVUS is safe and provides advantages regarding the evaluation of IC by depicting RVD and lesion length more reliably than standard DSA. More precise assessment of lesions resulted in the use of significantly larger devices.