Background

There has been growing use of intravascular ultrasound (IVUS) during lower extremity arterial and venous revascularization. Observational data suggest that the use of IVUS can improve periprocedural and long-term outcomes, but largescale prospective data remain limited. Consensus opinion regarding the appropriate use of IVUS during peripheral intervention is needed.

Objectives

The purpose of this consensus document is to provide guidance on the appropriate use of IVUS in various phases of peripheral arterial and venous interventions.

Methods

A 12-member writing committee was convened to derive consensus regarding the appropriate clinical scenarios for use of peripheral IVUS. The group iteratively created a 72-question survey representing 12 lower extremity arterial interventional scenarios. Separately, a 40-question survey representing 8 iliofemoral venous interventional scenarios was constructed. Clinical scenarios were categorized by interventional phases: preintervention, intraprocedure, and postintervention optimization. Thirty international vascular experts (15 for each survey) anonymously completed the survey instrument. Results were categorized by appropriateness using the median value and disseminated to the voting panel to reevaluate for any disagreement.

Results

Consensus opinion concluded that IVUS use may be appropriate during the preintervention phase for evaluating the etiology of vessel occlusion and plaque morphology in the iliac and femoropopliteal arteries. IVUS was otherwise rated as appropriate during iliac and femoropopliteal revascularization in most other preintervention scenarios, as well as intraprocedural and postprocedural optimization phases. IVUS was rated appropriate in all interventional phases for the tibial arteries. For iliofemoral venous interventions, IVUS was rated as appropriate in all interventional phases.

Conclusions

Expert consensus can help define clinical procedural scenarios in which peripheral IVUS may have value during lower extremity arterial and venous intervention while additional prospective data are collected.

中文翻译：

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在动脉和静脉下肢干预期间适当使用血管内超声

背景

在下肢动脉和静脉血运重建过程中，血管内超声 (IVUS) 的使用越来越多。观察性数据表明，IVUS 的使用可以改善围手术期和长期结果，但大规模前瞻性数据仍然有限。需要就在外周干预期间适当使用 IVUS 达成共识。

目标

本共识文件的目的是为在外周动脉和静脉干预的各个阶段适当使用 IVUS 提供指导。

方法

召集了一个由 12 名成员组成的编写委员会，以就使用外周 IVUS 的适当临床方案达成共识。该小组反复创建了一个包含 72 个问题的调查，代表 12 个下肢动脉介入方案。另外，构建了代表 8 个髂股静脉介入方案的 40 个问题的调查。临床情景按干预阶段分类：干预前、手术中和干预后优化。30 名国际血管专家（每次调查 15 名）匿名完成了调查工具。结果使用中值按适当性分类，并分发给投票小组以重新评估任何分歧。

结果

共识意见认为，IVUS 可能适合在介入前阶段评估髂和股腘动脉血管闭塞的病因和斑块形态。在大多数其他干预前情景以及术中和术后优化阶段，IVUS 在髂和股腘动脉血运重建期间被评为适当。IVUS 在胫骨动脉的所有介入阶段都被评为合适。对于髂股静脉干预，IVUS 在所有干预阶段都被评为适当。

结论

专家共识可以帮助确定外周 IVUS 在下肢动脉和静脉干预期间可能有价值的临床程序场景，同时收集额外的前瞻性数据。