IntraVascular UltraSound After Below-The-Knee Endovascular Therapy: an Observational Pilot Study

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Medical Imaging

Background:

• Restenosis is a significant limitation following below-the-knee endovascular therapy (BTK EVT).
• Digital subtraction angiography provides limited information for assessing post-EVT complications.
• Intravascular ultrasound (IVUS) is a promising imaging modality for evaluating BTK EVT outcomes.

Purpose of the Study:

• To investigate the association between IVUS-detected post-EVT lesions and major adverse limb events (MALE) after BTK EVT.
• To evaluate the diagnostic performance of IVUS in identifying lesions associated with MALE.

Main Methods:

• Prospective, single-arm observational pilot study involving 50 patients undergoing BTK EVT.
• IVUS was performed post-EVT to identify and characterize lesions (stenosis, wall irregularities, dissections, stenting errors).
• Patients were followed for 6 months with duplex ultrasound to assess for MALE (restenosis, occlusion, amputation).

Main Results:

• 66% of participants had at least one IVUS-detected lesion post-EVT.
• MALE occurred in 56% of participants within 6 months, with 75% of these having pre-existing IVUS lesions.
• IVUS demonstrated a sensitivity of 0.75 and specificity of 0.45 for detecting lesions associated with MALE.

Conclusions:

• IVUS shows good sensitivity in detecting post-treatment lesions that predict MALE after BTK EVT.
• A larger, well-powered study is required to confirm these findings and establish standardized reporting for IVUS-detected lesions.
• Future randomized trials should assess interventions for IVUS-detected lesions to reduce MALE risk.