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

Abstract

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.

Key Points

• The safety and efficacy of IVUS are confirmed for the distinct cohort of patients with IC.

• IVUS provides advantages for the evaluation of IC by depicting RVD and lesion length more reliably than standard DSA.

• More precise assessment of stenoses resulted in the selection of significantly larger devices, hence suggesting substantial clinical impact.

Citation Format

• Hartung V, Augustin AM, Gruschwitz P et al. Endovascular therapy in intermittent claudication: Impact of IVUS guidance on treatment decisions. Rofo 2025; 197: 682–689

Zusammenfassung

Hintergrund und Ziele

Aufgrund des besseren Langzeitergebnisses wird für Patienten mit peripherer arterieller Verschlusskrankheit (pAVK) und Claudicatio intermittens (CI) die konservative Therapie der Revaskularisation vorgezogen. Die Verwendung des intravaskulären Ultraschalls (IVUS) verbessert das Ergebnis der endovaskulären Therapie signifikant. Jedoch gibt es diesbezüglich kaum Daten für Patienten mit CI. Daher ist das Ziel dieser Studie, die Sicherheit und Effektivität des IVUS für Patienten mit CI zu untersuchen. Weiterhin soll die Diskrepanz zwischen IVUS und Angiografie und mögliche Konsequenzen für die Behandlung beurteilt werden.

Methoden

In einer einzentrischen prospektiven Kohortenstudie wurden 20 Patienten mit CI, femoropoplitealer Erkrankung und Indikation zur endovaskulären Therapie eingeschlossen. Prozedurbezogene Daten, sowie Diskrepanzen zwischen IVUS und Angiografie wurden erfasst.

Ergebnisse

Insgesamt wurden 30 Läsionen behandelt. IVUS-basierte Messungen lieferten signifikant höhere Referenzgefäßdurchmesser (RGD) und Läsionslängen im Vergleich zur Angiografie (RGD: 5,37 ± 0,71 mm vs. 4,74 ± 0,63 mm, p<.001, Läsionslänge: 62,4 ± 41,4 mm vs. 42,18 ± 30,2 mm, p<.001). Bei 24 von 30 Läsionen (80%) fand sich ein signifikanter Unterschied im RGD (definiert als ein Unterschied >0,5 mm) und der Läsionslänge (definiert als >20 mm). Durch den IVUS wurde bei 14 von 30 Läsionen eine größere Ballongröße gewählt (47%), bei 3 von 30 (10%) eine kleinere. Im Mittel wurden durch den IVUS signifikant größere Ballons (5,25 ± 0,62 mm vs. 4,74 ± 0,63 mm, p<.004) und längere Materialien gewählt (78,97 ± 44,19 mm vs. 42,18 ± 30,2, p<.001). Alle Interventionen waren technisch erfolgreich. Schwerwiegende unerwünschte Ereignisse traten nicht auf.

Schlussfolgerungen

IVUS ist sicher und durch die zuverlässigere Beurteilung des RGD und der Läsionslänge der alleinigen angiografischen Beurteilung der Gefäßläsionen überlegen. Eine präzisere Beurteilung der Läsionen führte zum Einsatz größerer und längerer Devices.

Kernaussagen

• Die Sicherheit und Wirksamkeit des IVUS bestätigt sich für die spezielle Kohorte der Patienten mit Claudicatio intermittens.

• IVUS ist zuverlässiger als die DSA für die Beurteilung des Referenzgefäßdurchmessers und der Läsionslänge.

• Die präzisere Beurteilung von Stenosen führte zur Wahl signifikant größerer Devices, welches die klinische Bedeutsamkeit nahelegt.

Keywords

intravascular ultrasound - intermittent claudication - peripheral arterial disease

Schlüsselwörter

Intravaskulärer Ultraschall - claudicatio intermittens - periphere arterielle Verschlusskrankheit

Publication History

Received: 20 April 2024

Accepted after revision: 29 July 2024

Article published online:
05 September 2024

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