Adjunctive Utilization of Intravascular Ultrasound in Peripheral Arterial Disease Treatment

Background: The utility and benefit of intravascular ultrasound (IVUS) has been well established in coronary interventions, however widespread adoption for peripheral interventions has lagged. The objectives of this review article were to discuss the technical components of IVUS, describe key learning pearls for IVUS utilization, and review the literature describing the clinical outcomes of endovascular peripheral arterial interventions using IVUS. Methods: A scoping review of the current literature utilizing Pubmed. Terms used to search the literature included “intravascular ultrasound (IVUS)” in conjunction with “peripheral arterial disease (PAD),” “endovascular interventions,” “chronic limb threatening ischemia,” “balloon angioplasty” “stenting,” “percutaneous coronary intervention,” and “outcomes.” All types of articles were reviewed including review articles, retrospective reviews, meta-analyses, and prospective observational and randomized studies. Results: Published literature regarding IVUS use in peripheral arterial interventions is heterogeneous and limited to mainly retrospective studies, registry analyses and metanalyses. Outcomes are generally favorable with the adjunct of IVUS compared to traditional angiography-driven peripheral interventions. The addition of IVUS improves stent expansion, stent patency, and reduces reintervention rates, particularly in infrainguinal arterial lesions. Long-term costs may also be lower with IVUS-guided procedures. Conclusions: Expert consensus largely supports the implementation of IVUS in endovascular interventions for peripheral arterial disease. However, more robust high-quality data evaluating the efficacy, durability, and cost of IVUS in peripheral arterial disease are still needed.