Angioplasty combined with intravascular ultrasound vs angioplasty alone in the treatment of peripheral arterial disease.

Background: Digital Subtraction Angiography (DSA) is the conventional imaging method for peripheral arterial disease (PAD) assessment but poses limitations for the estimation of the true vessel diameter, especially in diffuse disease. Intravascular ultrasound (IVUS) is used in coronary interventions, offering detailed insights. While IVUS is proven beneficial in coronary interventions, its role in peripheral arterial interventions is less well established. This meta-analysis aims to compare outcomes of peripheral percutaneous transluminal angioplasty (PTA) using angiography only (AO-PTA) versus angiography with IVUS (IVUS-PTA) in PAD. Materials and methods: A systematic review of PubMed, EMBASE, Cochrane, Scopus, and Web of Science databases from January 1996 to August 2024 was conducted. 13 studies met inclusion criteria, including RCTs, observational, and propensity-matched studies. Data extraction, quality assessment, and analyses were performed following PRISMA guidelines. Primary endpoint: freedom from target lesion reintervention (F-TLR) at 12 months. Secondary endpoints: bailout stenting, technical success, and freedom from major amputation (F-MA). Results: A total of 246,418 patients from 13 studies were included. F-TLR at 12-month follow-up was reported in 51,850 procedures. F-MA was reported in 155,933 procedures. IVUS-PTA showed significantly better F-MA and higher bailout stenting, but inferior F-TLR compared to AO-PTA. Technical success was reported in 555 procedures across 5 studies (0.2%). It trended higher with IVUS-PTA but with no statistical significance. Conclusions: IVUS-PTA is associated with superior F-MA and bailout stenting, but inferior F-TLR compared to AO-PTA. Further well-designed RCTs are needed to better support the use of IVUS's role PAD.