Predictability and usefulness of intravascular ultrasound-guided angioplasty in patients with femoropopliteal lesions.

INTRODUCTION

The aim of this study was to assess whether intravascular ultrasound (IVUS)-guided angioplasty in femoropopliteal lesions would improve clinical outcomes and predict restenosis.

EVIDENCE ACQUISITION

Studies in which IVUS-guided angioplasty was used for femoropopliteal lesions were searched from the MEDLINE, Embase, Web of Science, and Cochrane databases; articles with the full text were included. The primary endpoint of this study was primary patency at 12 months, while the secondary endpoints were primary patency at 24 months, freedom from target lesion revascularization (TLR) at 12 months, and correlation of restenosis with the distal external elastic membrane (EEM) area, postintervention minimum lumen area, lesion length, dissection, and calcification.

EVIDENCE SYNTHESIS

Altogether, 11 observational studies involving 1521 patients (1703 lesions) were analyzed. The quality of the evidence for 7 main outcomes was assessed as "very low" by The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) classification. The mean follow-up period was 1.5 years. The pooled rates were: 78% for 12-month primary patency (95% confidence interval [CI], 0.72-0.83), 74.3% for 24-month primary patency (95% CI: 0.71-0.78), and 80% for 12-month freedom from TLR (95% CI: 0.74-0.86). The 12-month primary patency of IVUS use (relative risk [RR], 2.01; 95% CI: 1.48-2.74) was higher compared to non-IVUS use. The minimum lumen (stent) area (standard mean difference [SMD] = -0.30; 95% CI: -0.46 to -0.15) and dissection (OR 1.58; 95% CI: 1.01-2.49, P=0.047), were associated with midterm patency in terms of restenosis.

CONCLUSIONS

In IVUS-guided angioplasty in patients with femoropopliteal lesions, the minimum lumen (stent) area and dissection were associated with restenosis. Nevertheless, there is limited and heterogeneous evidence regarding the usefulness and Predictability of IVUS in patients with peripheral arterial disease in the femoropopliteal artery, especially in long-term patency and as a predictor of declining patency. The optimal role of IVUS in such patients should be elucidated in the future.