Should Interventional Radiologists Incorporate Intravascular Ultrasound (IVUS) Into Their Daily Practice? A
Girija Agarwal1, Rayan Kamal2, Danial Saeed3
1Department of Interventional Radiology, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY, UK. girija178@gmail.com.
Cardiovascular and Interventional Radiology
|July 6, 2026
Summary
Intravascular ultrasound (IVUS)-guided peripheral vascular interventions (PVI) reduce amputation, mortality, and restenosis rates in peripheral artery disease (PAD) compared to angiography alone. Further randomized trials are needed to confirm these benefits.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Imaging
Background:
- Peripheral artery disease (PAD) affects millions globally, necessitating effective revascularization strategies.
- Angiography-guided interventions are standard, but limitations exist in visualizing complex lesions.
- Intravascular ultrasound (IVUS) offers real-time, cross-sectional imaging for improved procedural guidance.
Purpose of the Study:
- To systematically review and meta-analyze studies comparing IVUS-guided versus angiography-guided peripheral vascular interventions (PVI) for PAD.
- To assess the impact of IVUS guidance on key clinical outcomes including amputation, mortality, and revascularization rates.
Main Methods:
- A systematic review and meta-analysis adhering to PRISMA guidelines was conducted.
- Studies comparing IVUS-guided vs. angiography-guided PVI for PAD were included.
- Random-effects models were used to pool data from 25 studies involving over 1.1 million patients.
Main Results:
- IVUS guidance significantly reduced rates of amputation (RR 0.75), all-cause mortality (RR 0.86), target lesion revascularization (TLR) (RR 0.66), and restenosis (RR 0.74) compared to angiography.
- Major adverse limb events (MALE) showed a numerically lower rate with IVUS, but did not reach statistical significance.
- Technical success rates were comparable between IVUS-guided and angiography-guided PVI.
Conclusions:
- IVUS-guided PVI demonstrates significant benefits in reducing adverse outcomes for PAD patients compared to angiography alone.
- The current evidence base is largely observational, highlighting the need for high-certainty data.
- Further randomized controlled trials are warranted to definitively establish the superiority of IVUS guidance in PVI for PAD.
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