Expert Panel Supports Intravascular Ultrasound Use in Peripheral Interventions

Eric A. Secemsky, MD, MSc

Credit: LinkedIn

A multidisciplinary expert panel assembled by the Society for Cardiovascular Angiography & Interventions (SCAI) advocated for the increased use of intravascular ultrasound (IVUS) among patients undergoing lower extremity revascularization procedures.¹

The expert consensus roundtable was co-sponsored by five cardiovascular specialty societies, including the American Vein and Lymphatic Society (AVLS), American Venous Forum (AVF), Society of Interventional Radiology (SIR), Society for Vascular Medicine (SVM), and Society for Vascular Surgery (SVS).

Citing increasing evidence supporting the use of IVUS in peripheral arterial and deep venous intervention, the expert panel reviewed current challenges in treating lower extremity revascularization and the potential role of IVUS in addressing these challenges.¹

“Improvements in outcomes following peripheral vascular intervention have lagged compared to other endovascular treatments, such as percutaneous coronary intervention,” said Eric A. Secemsky, MD, MSc, the director of vascular intervention at Beth Israel Deaconess Medical Center, in a statement.² “Both clinical experience and evidence support the greater use of peripheral IVUS to reduce adverse events and extend the patency of our lower extremity revascularization procedures.”

Lower extremity revascularization is the central procedure for restoration of blood flow to the legs and feet among patients with peripheral arterial disease (PAD) and deep venous pathology.¹ Angiography is the primary imaging modality in revascularization but there are inherent limitations, including its ability to accurately size vessels, determine stenosis severity and length of lesions, analyze lesion morphology, or detect postintervention complications.

However, evidence has suggested the limitations stemming from angiography could be overcome using IVUS. Although a minimally invasive procedure for patients, IVUS allows for real-time detailed information about blood vessels, plaque composition, and blood flow characteristics for a more accurate diagnosis. The use of IVUS has shown improved outcomes following percutaneous coronary intervention and evidence has supported its benefit in peripheral vascular intervention.

The panel of 15 experts from the 6 cardiovascular specialty societies concentrated on challenges in the diagnosis and treatment of lower extremity revascularization, including gaps in both knowledge and available data.² The experts cited limitations in IVUS use including imaging quality, and the lack of additional features, such as vulnerable plaque determination.¹ They also noted barriers in the lack of standardized peripheral IVUS training, cost-related barriers to access, and the potential for increased procedure time.

As the evidence base for IVUS consisted mainly of retrospective observational data, the panel indicated a successful randomized controlled trial would provide critical evidence for the role of IVUS during peripheral interventions. But, as it may be challenging to perform on a large scale, experts supported the establishment of additional registries to augment clinical data. The panel also supported the incorporation of available data from retrospective studies and registries into national and international clinical guidelines.

Experts also supported the role of education in the appropriate use and adoption of IVUS, including formal certification for physicians. They also supported the inclusion of a minimum number of IVUS cases into the curriculum, including both arterial and venous experience. The panel indicated IVUS utilization will be a result of comfort with the technology, and this education would ideally begin in training programs and continue into practice.

The panel also cited the need for raised awareness and an altered perception of IVUS among physicians and reimbursement authorities. Experts noted the need to work closely with insurers and government agencies to develop treatment standards, guidelines, appropriateness criteria, and global quality metrics. They specifically indicated an increase in technology use does not imply inappropriateness and that continued investment in the role of the device will reduce this misinformation.

In the panel’s conclusion, the experts called for a commitment to further interdisciplinary collaboration and mutual exchange of information among physicians and healthcare professionals. Together, they indicated that treatment standards, formalized training, and global quality metrics are crucial factors required to improve patient care.

“The insights gained from this roundtable will help shape future research, training, and clinical guidelines in the field of lower extremity revascularization,” Secemsky said.² “By leveraging the power of IVUS, we can improve our ability to diagnose and treat patients, ultimately leading to better outcomes and quality of life.”

References

1. _{Multidisciplinary panel advocates for increased adoption of intravascular ultrasound (IVUS) in peripheral vascular interventions. EurekAlert! January 9, 2024. Accessed January 9, 2024. https://www.eurekalert.org/news-releases/1030470.}
2. _{Secemsky EA, Aronow HD, Kwolek CJ, et al. Intravascular Ultrasound Use in Peripheral Arterial and Deep Venous Interventions: Multidisciplinary Expert Opinion From SCAI/AVF/AVLS/SIR/SVM/SVS. JSCAI. January 9, 2024. Accessed January 9, 2024. https://www.jscai.org/article/S2772-9303(23)01207-3/fulltext.}