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Secemsky EA, Parikh SA, Kohi M, Lichtenberg M, Meissner M, Varcoe R, Holden A, Jaff M, Chalyan D, Clair D, Hawkins B, Rosenfield K. Intravascular ultrasound guidance for lower extremity arterial and venous interventions. EUROINTERVENTION 2022; 18:598-608. [PMID: 35438078 PMCID: PMC10331977 DOI: 10.4244/eij-d-21-00898] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/28/2022] [Indexed: 11/23/2022]
Abstract
This review details the utility of intravascular ultrasound (IVUS) for the management of peripheral artery and venous disease. The purpose of this document is to provide an update in the use of IVUS in peripheral arterial and venous pathology and demonstrate the use of IVUS as a practical diagnostic imaging procedure to evaluate and treat peripheral vascular disorders. IVUS, a diagnostic tool that relies on sound waves to produce precise images of the vessel being evaluated, was originally introduced to the medical community for the purposes of peripheral artery imaging, though it was quickly adapted for coronary interventions with positive outcomes. The utility of IVUS includes vessel measurement, pre- and post-procedural planning, treatment optimisation, and detection of thrombus, dissection or calcium severity. While angiography remains the standard imaging approach during peripheral intervention, multiple observational studies and small prospective trials have shown that in comparison, IVUS provides more accurate imaging detail, which may improve procedural outcomes. IVUS can also address limitations of angiography, including the need to administer contrast medium and eliminate the ambiguity associated with other forms of imaging. This review provides contemporary examples of where IVUS is being used during peripheral intervention as well as representative imaging to serve as a resource for the practising clinician.
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Affiliation(s)
- Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sahil A Parikh
- Center for Interventional Vascular Therapy and Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Maureen Kohi
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | | | - Mark Meissner
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Ramon Varcoe
- Department of Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- The Vascular Institute, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Andrew Holden
- Department of Interventional Radiology, Auckland City Hospital, Auckland, New Zealand
| | | | - David Chalyan
- Department of Radiological Sciences, University of California-Irvine, Irvine, CA, USA
- Philips Healthcare, Amsterdam, the Netherlands
| | - Daniel Clair
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Beau Hawkins
- Division of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Ito N, Hishikari K, Yoshikawa H, Tsujihata S, Abe F, Kanno Y, Iiya M, Murai T, Hikita H, Takahashi A, Yonetsu T, Sasano T. Angiographic flow velocity predicts lower limb outcomes after endovascular therapy: Application of the frame count method. Vasc Med 2021; 27:39-46. [PMID: 34286654 DOI: 10.1177/1358863x211025613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Several factors related to lesion characteristics and endovascular therapy (EVT) procedures have been reported to affect primary patency after EVT. However, it is unknown why these factors were associated with primary patency. We hypothesized patency failure was related to poor blood flow in affected arteries. METHODS This retrospective study included 131 consecutive patients who had received EVT with bare metal stents for peripheral artery disease caused by femoropopliteal artery lesions. Based on the tertile post-EVT flow velocity of the superficial femoral artery (SFA), patients were divided into high (n = 43), middle (n = 44), and low (n = 44) flow velocity groups. Flow velocity was measured using the frame count method. We measured incidence of major adverse limb events (MALE), composed of target lesion revascularization (TLR), non-TLR, and major amputation. RESULTS At a median follow-up period of 22.7 months, MALE had occurred in 7 (16.3%), 10 (22.7%), and 29 (65.9%) of patients from the high, middle, and low SFA flow velocity groups, respectively (p < 0.001). Kaplan-Meier analysis showed incidence of MALE was significantly higher in the patients of low SFA flow velocity (log-rank test χ2 = 38.8, p < 0.001). Multivariate analysis found low SFA flow velocity to be an independent predictor for MALE (hazard ratio: 4.42; 95% CI: 2.27 to 8.60; p < 0.001) as was ankle-brachial index. CONCLUSION Post-EVT SFA flow velocity for femoropopliteal artery lesions treated with bare metal stents is an independent predictor of limb patency. The frame count method for assessing arterial flow velocity is convenient and has potential for wide applications in EVT.
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Affiliation(s)
- Naruhiko Ito
- Department of Cardiology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | | | | | | | - Fumiyuki Abe
- Department of Cardiology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Yoshinori Kanno
- Department of Cardiology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Munehiro Iiya
- Department of Cardiology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Tadashi Murai
- Department of Cardiology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Hiroyuki Hikita
- Department of Cardiology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | | | - Taishi Yonetsu
- Cardiovascular Medicine, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Tetsuo Sasano
- Cardiovascular Medicine, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
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Javed IN, Hawkins BM. Aorto-iliac peripheral artery disease. Prog Cardiovasc Dis 2021; 65:9-14. [PMID: 33631164 DOI: 10.1016/j.pcad.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
Aorto-iliac disease is a common manifestation of atherosclerosis. Individuals with this condition are at heightened cardiovascular risk, and may have limb symptoms ranging from claudication to limb-threatening ischemia. A regimen of medical therapy, risk factor modification, and exercise is first line therapy. Revascularization is reserved for individuals with lifestyle-limiting claudication despite conservative therapy and in those with chronic limb-threatening ischemia. Multiple endovascular therapies are now available that enable even the most complex aorto-iliac lesions to be approached and treated with safe and durable results.
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Affiliation(s)
- Isma N Javed
- Cardiovascular Section, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - Beau M Hawkins
- Cardiovascular Section, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America.
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Kadoya Y, Zen K, Iida O, Yamamoto Y, Kawasaki D, Yamauchi Y, Shintani Y, Sugano T, Yokoi H, Matoba S, Nakamura M. Thrombotic Lesions are Associated with Poor Outcomes after Endovascular Treatment in Patients with Non-Acute Aortoiliac Total Occlusions. J Atheroscler Thromb 2021; 28:1323-1332. [PMID: 33563884 PMCID: PMC8629701 DOI: 10.5551/jat.61150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim: The post-endovascular treatment outcomes of thrombotic lesions remain unclear. This study aimed to investigate the effects of thrombotic lesions on post-endovascular treatment outcomes in patients with non-acute aortoiliac total occlusions. Methods: This subanalysis of a multicenter prospective observational registry study included patients from 64 institutions in Japan between April 2014 and April 2016. A total of 346 patients (394 limbs; median age, 72 years), including 186 men, underwent endovascular treatment for non-acute aortoiliac total occlusions and were included. The patients were classified as having thrombotic or non-thrombotic lesions. The primary (1-year primary patency rate) and secondary (1-year overall survival rate) endpoints were evaluated. Results: Thrombotic lesions were identified in 18.5% (64/346) of the patients. The 1-year primary patency (85.9% versus 95.4%, log-rank
p
<.001) and overall survival (90.6% versus 97.9%, log-rank
p
=.003) rates were significantly lower in the thrombotic group than in the non-thrombotic group. Thrombotic lesions had significant effects on the post-endovascular treatment outcomes, with adjusted hazard ratios of 3.91 (95% confidence interval, 1.64–9.34,
p
=.002) for primary patency and 4.93 (95% confidence interval, 1.59–15.3,
p
=.006) for all-cause mortality.
Conclusions: Thrombotic lesions were associated with 1-year restenosis and all-cause mortality after endovascular treatment for non-acute aortoiliac total occlusions. Endovascular treatment strategies should be carefully planned for patients with thrombotic lesions.
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Affiliation(s)
- Yoshito Kadoya
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Kan Zen
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Osamu Iida
- Cardiovascular Centre, Kansai Rosai Hospital
| | - Yoshito Yamamoto
- Department of Cardiovascular Medicine, Iwaki Kyoritsu General Hospital
| | | | | | | | - Teruyasu Sugano
- Department of Cardiovascular Medicine, Yokohama City University Hospital
| | | | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University, Ohashi Medical Centre
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Rothstein E, Aronow H, Hawkins BM, Young MN. Intravascular Imaging for Peripheral Vascular Disease and Endovascular Intervention. CURRENT CARDIOVASCULAR IMAGING REPORTS 2020. [DOI: 10.1007/s12410-020-9526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tokuda T, Hirano K, Soga Y, Iida O, Kawasaki D, Yamauchi Y, Suzuki K, Kamoi D, Tazaki J. Comparison of 3‐year clinical outcomes after endovascular therapy for aortoiliac artery occlusive disease between patients with and without hemodialysis: Subanalysis of the REAL‐AI registry. Catheter Cardiovasc Interv 2018; 92:1345-1351. [DOI: 10.1002/ccd.27865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/25/2018] [Accepted: 08/10/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Takahiro Tokuda
- Department of Cardiovascular MedicineSaiseikai Yokohama City Eastern Hospital Yokohama Kanagawa Japan
| | - Keisuke Hirano
- Department of Cardiovascular MedicineSaiseikai Yokohama City Eastern Hospital Yokohama Kanagawa Japan
| | - Yoshimitsu Soga
- Department of CardiologyKokura Memorial Hospital Kitakyushu Japan
| | - Osamu Iida
- Cardiovascular CenterKansai Rosai Hospital Nishinomiya Hyogo Japan
| | - Daizo Kawasaki
- Cardiovascular Division, Department of Internal MedicineMorinomiya Hospital Osaka Japan
| | - Yasutaka Yamauchi
- Department of Cardiology, Cardiovascular CenterKikuna Memorial Hospital Yokohama Kanagawa Japan
| | - Kenji Suzuki
- Department of CardiologySaiseikai Central Hospital Tokyo Japan
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Shi C, Luo X, Guo J, Najdovski Z, Fukuda T, Ren H. Three-Dimensional Intravascular Reconstruction Techniques Based on Intravascular Ultrasound: A Technical Review. IEEE J Biomed Health Inform 2018; 22:806-817. [DOI: 10.1109/jbhi.2017.2703903] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Horimatsu T, Fujii K, Fukunaga M, Miki K, Nishimura M, Naito Y, Shibuya M, Imanaka T, Kawai K, Tamaru H, Sumiyoshi A, Saita T, Masuyama T, Ishihara M. The distribution of calcified nodule and plaque rupture in patients with peripheral artery disease: an intravascular ultrasound analysis. Heart Vessels 2017; 32:1161-1168. [DOI: 10.1007/s00380-017-0984-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 04/28/2017] [Indexed: 11/25/2022]
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Spiliopoulos S, Kitrou P, Katsanos K, Karnabatidis D. FD-OCT and IVUS intravascular imaging modalities in peripheral vasculature. Expert Rev Med Devices 2017; 14:127-134. [PMID: 28064551 DOI: 10.1080/17434440.2017.1280391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Intra-Vascular Ultra-Sound (IVUS) and Frequency Domain-Optical Coherence Tomography (FD-OCT), in vivo, intra-vascular, imaging modalities, widely used in the field of coronary disease, have been recently implemented in peripheral endovascular procedures, for procedural assessment, plaque characterization and determination of predictors of treatment outcomes. Their unique characteristics have also been used in order to provide additional features and improve the performance of re-entry devices and atherotomes. Areas covered: Present review focuses on available literature regarding these two promising imaging technologies in the peripheral vasculature, highlighting the added value produced by their use in endovascular therapy, their limitations and their utilization in new endovascular devices. Authors also provide their future perspective and the possible benefits in understanding vascular behavior and lesion characterization in peripheral endovascular interventions. Expert commentary: By providing both quantitative but also qualitative data on vessel and lesion morphology, intravascular imaging modalities offer a valid solution for endovascular treatment evaluation and outcome presentation homogeneity.
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Affiliation(s)
- S Spiliopoulos
- a 2nd Department of Radiology, Division of Interventional Radiology , Attikon University General Hospital , Athens , Greece
| | - P Kitrou
- b Interventional Radiology Department , Patras University Hospital , Patras , Greece
| | - K Katsanos
- b Interventional Radiology Department , Patras University Hospital , Patras , Greece
- c Interventional Radiology Department , Guy's and St Thomas Hospitals, NHS Foundation Trust , London , UK
| | - D Karnabatidis
- b Interventional Radiology Department , Patras University Hospital , Patras , Greece
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