Appropriate Use of Intravascular Ultrasound During Arterial and Venous Lower Extremity Interventions.

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. 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. 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. 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. 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.

Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Funding Support and Author Disclosures Dr Secemsky is funded in part by National Institutes of Health/National Heart, Lung, and Blood Institute grant K23HL150290. This review was funded in part by unrestricted educational grants from Boston Scientific and Philips IGT. These companies have not seen or participated in the creation of this manuscript, including no contribution in the writing of the manuscript, significant edits, or the decision whether to submit. Dr Secemsky is a consultant and Speakers Bureau and/or advisory board member for Abbott, Bayer, Becton, Dickinson and Company, Boston Scientific, Cook, Cardiovascular Systems, Inc., Endovascular Engineering, Inari, Janssen, Medtronic, Philips, and VentureMed; has received grants to the institution from the National Institutes of Health/National Heart, Lung, and Blood Institute (K23HL150290), the U.S. Food and Drug Administration, Harvard Medical School (Shore Faculty Development Award), AstraZeneca, BD, Boston Scientific, Cook, Cardiovascular Systems, Inc., Laminate Medical, Medtronic, and Philips. Dr Kohi is a board member at VIVA Physicians; and is a global principal investigator of the ELEGANCE (Drug-Eluting Registry: Real-World Treatment of Lesions in the Peripheral Vasculature) registry with Boston Scientific but is not being personally compensated. Dr Rosenfield is a consultant and scientific advisory board member for Angiodynamics, Boston Scientific, Contego, InspireMD, Magneto, Mayo Clinic, Neptune Medical, Philips, Summa Therapeutics, Surmodics, Thrombolex, and Truvic; has received grants to the institution from the National Institutes of Health and Boston Scientific; holds equity in Accolade, Access Vascular, Althea Medical, Contego, Cruzar Systems, Embolitech, Endospan, JanaCare, Magneto, Orchestra, PQ Bypass, Shockwave, Thrombolex, Truvic, and Valcare; and is a board member for the National PERT Consortium, a not-for-profit 501(c)(3) organization dedicated to advancing treatment and improving outcomes in pulmonary embolism. Dr Lichtenberg has received honoraria for lectures from Cagent Vascular, CR Bard, Boston Scientific, AB Medica, Philips, Terumo, Biotronik, Veryan, and Medtronic; has received honoraria for advisory board activities from Cagent Vascular, Biotronik, Veryan, Boston Scientific, Philips, Soundbite, Limflow, Covellus, and Medtronic; has participated in clinical trials for Cagent Vascular, Biotronik, CR Bard, Verya, Boston Scientific, LimFlow, Terumo, and Philips; and has received research funding from Cagent Vascular, Biotronik, Boston Scientific, Veryan, plusMedica, Philips, and CR Bard. Dr Meissner has served as a consultant for Cook Medical for a project using a Delphi consensus panel for venous stenting; Dr Varcoe consults for Medtronic, Abbott, BD Bard, Philips Healthcare, Intervene, and Surmodics; Dr Holden is a medical advisory board member for Medtronic, Gore, and Boston Scientific; and is a clinical investigator for Bard/BD, Boston Scientific, Cagent Medical, Cook Medical, Endologix, Endospan, Gore Medical, Intact Vascular, Medtronic, Philips, Reflow Medical, Shockwave Medical, and TriReme Medical. Dr Jaff is a part-time employee at Boston Scientific; is a consultant at Glide Healthcare; and holds equity investments in R3 Vascular, Nectero, Vactronix, and EFemoral. Dr Chalyan is an employee at Philips IGT. Dr Clair discloses his involvement with Boston Scientific, Elastimed, Endologix, and Medtronic and clarifies that he does not receive any income from these relationships, as all the income goes to the organization by which he is employed; and serves as a data and safety monitoring board member for Bard/Becton, Dickinson and Company and Boston Scientific (all income goes to the medical group). Dr Hawkins is a consultant at Baim; and conducts institutional research at Behring, Hemostemix, and the National Institutes of Health/National Heart, Lung, and Blood Institute. Dr Parikh is an advisory board member for Abbott, Boston Scientific, Medtronic, Philips, and Cordis; has conducted research for Abbott, Boston Scientific (data and safety monitoring board), Shockwave, Surmodics, TriReme, Veryan Medical, Acotec, and MedAlliance; and is a consultant for Abiomed, Canon, Inari, Penumbra, and Terumo. Dr Mosarla has reported that she has no relationships relevant to the contents of this paper to disclose.