Impact of Intravascular Ultrasound Guidance on Strategy and Patency in Endovascular Treatment of Peripheral Arterial...

To evaluate whether intravascular ultrasound (IVUS) guidance influences procedural strategy and improves patency compared with angiography-guided endovascular treatment.

In this randomized clinical trial, patients with lower limb peripheral arterial disease were assigned 1:1 to IVUS-guided or angiography-only procedures. Primary outcomes included primary patency, assisted primary patency, and secondary patency. Secondary outcomes included target vessel revascularization, target lesion revascularization, target limb revascularization, and major amputation. In the IVUS group, changes in procedural strategy and detection of residual lesions were also analyzed.

A total of 59 patients (65 procedures) were included. The IVUS group included 27 patients (33 procedures; mean age 71.3 years; 55.5% men). Occlusions comprised 43.8% of lesions, with 53.1% Trans-Atlantic Inter-Society Consensus classification D and 56.3% Global Limb Anatomic Staging System classification 3. The control group included 32 patients (32 procedures; mean age 70.3 years; 81.8% men) with comparable lesion profiles (P > 0.05). IVUS prompted changes in therapeutic strategy in 72% of procedures (22% device type, 78% sizing) and identified 28.1% significant residual lesions versus 6.2% with angiography, with 100% technical success. At a median follow-up of 7 months, primary, assisted primary, and secondary patency were higher in the IVUS group (95%, 95%, and 100%) compared with the control group (80%, 80%, and 90%) (P < 0.05). Reintervention rates were significantly lower in the IVUS group (target vessel revascularization 0% vs. 18.2%, target lesion revascularization 3.1% vs. 21.2%; P < 0.05), whereas no significant differences were observed in limb revascularization (target limb revascularization 0% vs. 6.1%; P > 0.05) or major amputation (0% vs. 6.1%; P > 0.05).

IVUS guidance significantly influences procedural decision-making and improves short-term to midterm patency outcomes. Its use appears particularly beneficial in complex lesions, where enhanced lesion characterization and optimization of device selection may reduce residual disease and reintervention rates.