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Reduction of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease Combining Fiber Optic RealShape Technology and Intravascular Ultrasound
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Reduction of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease Combining Fiber Optic RealShape Technology and Intravascular Ultrasound

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Intravascular Ultrasound in Chronic Limb-Threatening Ischemia Endovascular Revascularization: A Multidisciplinary

Marc-André d'Entremont1,2,3, Eric A Secemsky4,5, Graham R McClure1,6

  • 1Population Health Research Institute, Hamilton, Ontario, Canada.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|May 25, 2026
PubMed

Insights

Barriers to using intravascular ultrasound (IVUS) for chronic limb-threatening ischemia (CLTI) revascularization include cost, procedural time, and lack of data. Most specialists are willing to randomize patients in trials to clarify IVUS benefits.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Interventional Radiology

Background:

  • Intravascular ultrasound (IVUS) shows potential for guiding endovascular revascularization in chronic limb-threatening ischemia (CLTI).
  • Current adoption and utilization of IVUS in CLTI remain limited despite its potential benefits.

Purpose of the Study:

  • To assess clinical equipoise and willingness to randomize among specialists regarding IVUS use in CLTI.
  • To identify perceived barriers to the adoption and expansion of IVUS for endovascular revascularization in CLTI patients.

Main Methods:

  • A 13-question anonymous online survey was distributed to interventional radiologists, vascular surgeons, and interventional cardiologists in the US, Canada, and UK.
  • The survey evaluated opinions on IVUS use, clinical equipoise, and willingness to participate in randomized trials for CLTI.

Main Results:

  • 105 operators responded (5.7% response rate).
  • Key barriers identified were cost/reimbursement (69.5%), longer procedural time (47.6%), and lack of randomized evidence (39.0%).
  • 80.0% agreed a large randomized trial was needed, and 77.1% were willing to randomize patients.

Conclusions:

  • Cost, procedural time, and insufficient randomized evidence are major barriers to IVUS use in CLTI revascularization.
  • Multidisciplinary specialists exhibit clinical equipoise and willingness to randomize.
  • Large randomized controlled trials are essential to guide clinical practice for IVUS in CLTI.
Abstract

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