Peripheral interventions

Intravascular ultrasound guidance for lower extremity arterial and venous interventions

EuroIntervention 2022;18:598-608. DOI: 10.4244/EIJ-D-21-00898

Eric Secemsky
Eric A. Secemsky1,2,3, MD; Sahil A. Parikh4, MD; Maureen Kohi5, MD; Michael Lichtenberg6, MD; Mark Meissner7, MD; Ramon Varcoe8,9,10, MBBS; Andrew Holden11, MBChB; Michael Jaff2, DO; David Chalyan12,13, MD; Daniel Clair14, MD; Beau Hawkins15, MD; Kenneth Rosenfield16, MD
1. Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA; 2. Harvard Medical School, Boston, MA, USA; 3. Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; 4. Center for Interventional Vascular Therapy and Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA; 5. Department of Radiology, University of North Carolina, Chapel Hill, NC, USA; 6. Clinic for Angiology, Klinikum Arnsberg, Arnsberg, Germany; 7. Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA; 8. Department of Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia; 9. Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; 10. The Vascular Institute, Prince of Wales Hospital, Sydney, New South Wales, Australia; 11. Department of Interventional Radiology, Auckland City Hospital, Auckland, New Zealand; 12. Department of Radiological Sciences, University of California-Irvine, Irvine, CA, USA; 13. Philips Healthcare, Amsterdam, the Netherlands; 14. Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; 15. Division of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; 16. Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA

This review details the utility of intravascular ultrasound (IVUS) for the management of peripheral artery and venous disease. The purpose of this document is to provide an update in the use of IVUS in peripheral arterial and venous pathology and demonstrate the use of IVUS as a practical diagnostic imaging procedure to evaluate and treat peripheral vascular disorders. IVUS, a diagnostic tool that relies on sound waves to produce precise images of the vessel being evaluated, was originally introduced to the medical community for the purposes of peripheral artery imaging, though it was quickly adapted for coronary interventions with positive outcomes. The utility of IVUS includes vessel measurement, pre- and post-procedural planning, treatment optimisation, and detection of thrombus, dissection or calcium severity. While angiography remains the standard imaging approach during peripheral intervention, multiple observational studies and small prospective trials have shown that in comparison, IVUS provides more accurate imaging detail, which may improve procedural outcomes. IVUS can also address limitations of angiography, including the need to administer contrast medium and eliminate the ambiguity associated with other forms of imaging. This review provides contemporary examples of where IVUS is being used during peripheral intervention as well as representative imaging to serve as a resource for the practising clinician.

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