Intravascular Ultrasound in Endovascular Interventions for Peripheral Artery Disease

Purpose of review: This article reviews the contemporary evidence for the use of intravascular ultrasound (IVUS) for peripheral arterial disease (PAD) endovascular interventions. Recent findings: Earlier observational studies have shown that IVUS use for endovascular interventions is associated with improved patency rates and freedom from restenosis. Recently, a randomized trial demonstrated that IVUS was associated with a significantly larger mean vessel diameter than angiography, higher freedom from binary restenosis at 12 months. Recent large observational studies have suggested that IVUS is also associated with improved clinical outcomes. One study of 543,488 Medicare beneficiaries showed that IVUS use was associated with lower risk of major adverse limb events, including amputation and arterial thrombosis. Another Japanese analysis of 85,649 showed that the IVUS was associated with lower incidence of amputation at 12 months. Summary: The benefit of IVUS use in coronary interventions is well established, but the translation of these benefits to endovascular interventions has lagged behind, with a growing body of evidence supporting its use, mainly observational studies. Randomized trials are emerging to better document the benefit of IVUS in endovascular interventions.