The Impact of Intravascular Ultrasound Use on 1-Year Outcomes After Infrapopliteal Endovascular Intervention

Data supporting the use of intravascular ultrasound (IVUS) in aortoiliac and femoropopliteal endovascular intervention are becoming increasingly robust, but data in the infrapopliteal circulation remain limited. The aim of this study was to evaluate the association between IVUS use and 1-year outcomes after infrapopliteal intervention.

All infrapopliteal endovascular interventions that occurred between 2018-2021 at a single academic medical center were retrospectively reviewed. Cases were separated into 2 cohorts based on the use of IVUS. Clinical characteristics, procedural data, and imaging were collected up to 1-year postintervention. The primary outcome of interest was 1-year binary restenosis. Secondary outcomes included rates of 1-year target lesion revascularization, amputation, major adverse limb events, and all-cause mortality.

One hundred patients with 142 lesions were included. IVUS was used in 23% of cases. Baseline characteristics, lesion characteristics, and treatment modalities did not differ significantly between cohorts. At 1 year, cases with IVUS utilization had significantly lower rates of binary restenosis (22% vs 57%; P = .004) and substantially lower rates of target lesion revascularization (13% vs 33%; P = .06). Rates of amputation, major adverse limb events, and mortality did not differ significantly. In multivariate analysis, lesions treated with IVUS were significantly less likely to have binary restenosis at 1 year when compared with angiography alone (odds ratio, 0.18; 95% CI, 0.05-0.62; P = .007).

Intravascular ultrasound use was associated with lower rates of 1-year restenosis when compared to angiography alone, even after correcting for differences in clinical and procedural characteristics. These findings support the need for a prospective randomized trial evaluating the impact of IVUS use on outcomes after infrapopliteal endovascular intervention.