Endovascular therapy in intermittent claudication: Impact of IVUS guidance on treatment decisions.

IF 1.3 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Rofo-fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgebenden Verfahren Pub Date : 2024-09-05 DOI:10.1055/a-2379-8857

Viktor Hartung, Anne Marie Augustin, Philipp Gruschwitz, Jan-Peter Grunz, Jonas Knarr, Ralph Kickuth

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Abstract

Conservative therapy is favored over revascularization for patients with peripheral arterial disease (PAD) and intermittent claudication (IC) owing to the better long-term results. The adjunctive use of intravascular ultrasound (IVUS) significantly improves endovascular therapy. However, data on IVUS and IC is scarce. Therefore, the aim of this investigation was to determine the safety and efficacy of IVUS in patients with IC and to evaluate discrepancies compared to angiography and potential consequences for treatment.This was a single-center prospective cohort study. Twenty patients with IC and femoropopliteal disease eligible for endovascular therapy were enrolled. Procedural data and discrepancies between IVUS and angiography were recorded.In total, 30 lesions were treated. IVUS-based measurements yielded substantially higher reference vessel diameters (RVD) and lesion lengths compared to DSA alone (RVD: 5.37 ± 0.71 mm vs. 4.74 ± 0.63 mm, p<.001, lesion length: 62.4 ± 41.4 mm vs. 42.18 ± 30.2 mm, p<.001). In 24 of 30 lesions (80%), a significant discrepancy in RVD (defined as difference >0.5 mm) and lesion length (defined as >20 mm) was determined between IVUS and standard DSA. Subsequently, IVUS assessment led to upsizing in 14 of 30 lesions (47%) and downsizing in 3 of 30 lesions (10%). On average, IVUS led to the selection of considerably larger balloons (5.25 ± 0.62 vs. 4.74 ± 0.63, p<.004) and device length (78.97 ± 44.19 mm vs. 42.18 ± 30.2, p<.001). Serious adverse events did not occur. Technical success was achieved in all cases.IVUS is safe and provides advantages regarding the evaluation of IC by depicting RVD and lesion length more reliably than standard DSA. More precise assessment of lesions resulted in the use of significantly larger devices. · The safety and efficacy of IVUS are confirmed for the distinct cohort of patients with IC.. · IVUS provides advantages for the evaluation of IC by depicting RVD and lesion length more reliably than standard DSA.. · More precise assessment of stenoses resulted in the selection of significantly larger devices, hence suggesting substantial clinical impact.. Hartung V, Augustin AM, Gruschwitz P et al. Endovascular therapy in intermittent claudication: Impact of IVUS guidance on treatment decisions. Fortschr Röntgenstr 2024; DOI 10.1055/a-2379-8857.

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间歇性跛行的血管内治疗：IVUS引导对治疗决策的影响。

对于患有外周动脉疾病（PAD）和间歇性跛行（IC）的患者来说，保守疗法比血管重建术更受青睐，因为保守疗法的长期效果更好。辅助使用血管内超声（IVUS）可显著改善血管内治疗。然而，有关 IVUS 和 IC 的数据却很少。因此，本研究旨在确定IVUS在IC患者中的安全性和有效性，并评估与血管造影相比的差异以及对治疗的潜在影响。这项研究是一项单中心前瞻性队列研究，共纳入了20名符合血管内治疗条件的股骨头坏死患者。共治疗了30处病变。与单纯的 DSA 相比，基于 IVUS 的测量得出的参考血管直径（RVD）和病变长度要高得多（RVD：5.37 ± 0.71 mm vs. 4.74 ± 0.63 mm，p0.5 mm），病变长度（定义为 >20 mm）在 IVUS 和标准 DSA 之间确定。随后，IVUS 评估导致 30 个病变中的 14 个病变（47%）扩大，30 个病变中的 3 个病变（10%）缩小。平均而言，IVUS 导致选择了更大的球囊（5.25 ± 0.62 vs. 4.74 ± 0.63, p

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来源期刊

Rofo-fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgebenden Verfahren 医学-核医学

CiteScore

1.20

自引率

5.60%

发文量

340

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