A comparative outcome of infrainguinal vessel endovascular intervention by intravascular ultrasound-guided (IVUS) versus angiography-guided in chronic limb-threatening ischemia at Phramongkutklao Hospital
Article Sidebar
Main Article Content
Abstract
Objective : Chronic limb-threatening ischemia makes many patients lose limbs worldwide. Treatment strategy for this disease is important. The endovascular treatment-first strategy (EVT) is preferred. Today, intravascular ultrasound was developed for evaluation of more vessel pathology details. It gives more information during endovascular surgery. The aim of the study is to prove the outcome of intravascular ultrasound (IVUS) guided endovascular intervention in comparison with angiographic guided endovascular intervention in chronic limb-threatening ischemia at Phramongkutklao Hospital.
Method: A single-center, retrospective cohort study was created. Data were collected from January 2018 to December 2022. The data of chronic limb-threatening ischemia patients who underwent endovascular surgery were collected. Then, the patients were separated into 2 groups: the control group with angiographic guide endovascular intervention, and the study group with IVUS guide endovascular intervention. Major adverse limb events (MALE) in 6 months and major adverse cardiac events (MACE) in 30 days are the primary outcomes of this study.
Result: 98 limbs from 90 patients were included. Angiographic guide endovascular intervention was performed on 69 limbs. And IVUS guide endovascular intervention was performed on 29 limbs. There was no difference in patient baseline characteristic and severity of disease. The overall technical success rates are 100%. After calculating by Chi-Square tests, 6-month MALE are equal in both groups (angiography 20.3% vs IVUS 20.7%; p=0.964). Similar to 30-day MACE, the results are not different in both groups (angiography 8.7% vs IVUS 10.3%; p=0.796)
Conclusion: IVUS-guided endovascular interventions do not increase limb salvage rate compared to angiographic guides in short-term outcomes. Other benefits of this imaging technique, such as the detection rate of post-angioplasty dissection and the accurate selection of stent size, require further study in large populations.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles in this journal are copyrighted by the Royal Thai Army Medical Department and published under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license.
may be read and used for academic purposes, such as teaching, research, or citation, with proper credit given to the author and the journal.
Use or modification of the articles is prohibited without permission.
Statements expressed in the articles are solely the opinions of the authors.
Authors are fully responsible for the content and accuracy of their articles.
Any other republication of the articles requires permission from the journal.
References
Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, et al. Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. Eur J Vasc Endovasc Surg. 2019;58(1s):S1-S109.e33.
Loffroy R, Falvo N, Galland C, Fréchier L, Ledan F, Midulla M, et al. Intravascular Ultrasound in the Endovascular Treatment of Patients With Peripheral Arterial Disease: Current Role and Future Perspectives. Front Cardiovasc Med. 2020;7:551861.
Pliagas G, Saab F, Stavroulakis K, Bisdas T, Finton S, Heaney C, et al. Intravascular Ultrasound Imaging Versus Digital Subtraction Angiography in Patients with Peripheral Vascular Disease. J Invasive Cardiol. 2020;32(3):99-103.
Soga Y, Takahara M, Ito N, Katsuki T, Imada K, Hiramori S, et al. Clinical impact of intravascular ultrasound-guided balloon angioplasty in patients with chronic limb threatening ischemia for isolated infrapopliteal lesion. Catheter Cardiovasc Interv. 2021;97(3):E376-e84.
Fujihara M, Yazu Y, Takahara M. Intravascular Ultrasound-Guided Interventions for Below-the-Knee Disease in Patients With Chronic Limb-Threatening Ischemia. J Endovasc Ther. 2020;27(4):565-74.
Iida O, Takahara M, Soga Y, Suzuki K, Hirano K, Kawasaki D, et al. Efficacy of intravascular ultrasound in femoropopliteal stenting for peripheral artery disease with TASC II class A to C lesions. J Endovasc Ther. 2014;21(4):485-92.
Panaich SS, Arora S, Patel N, Patel NJ, Savani C, Patel A, et al. Intravascular Ultrasound in Lower Extremity Peripheral Vascular Interventions: Variation in Utilization and Impact on InHospital Outcomes From the Nationwide Inpatient Sample (2006-2011). J Endovasc Ther. 2016;23(1):65-75.
Sheikh AB, Anantha-Narayanan M, Smolderen KG, Jelani QU, Nagpal S, Schneider M, et al. Utility of Intravascular Ultrasound in Peripheral Vascular Interventions: Systematic Review and Meta-Analysis. Vasc Endovascular Surg. 2020;54(5):413-22.
Mills JL, Sr., Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN, et al. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg. 2014;59(1):220-34.e1-2.
