Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Division of Cardiology, Department of Medicine, New York University Medical Center, New York, New York, USA.
JACC Cardiovasc Interv. 2022 Aug 8;15(15):1558-1568. doi: 10.1016/j.jcin.2022.04.034.
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.
在下肢动静脉血运重建过程中，越来越多地使用血管内超声（IVUS）。观察性数据表明，IVUS 的使用可以改善围手术期和长期结果，但大规模的前瞻性数据仍然有限。需要就外周介入治疗中 IVUS 的适当使用达成共识意见。
本共识文件旨在提供关于在周围动脉和静脉介入治疗的各个阶段中适当使用 IVUS 的指导。
召集了一个由 12 名成员组成的写作委员会，以就外周 IVUS 的适当临床情况达成共识。该小组反复制定了 72 个问题的调查，代表 12 个下肢动脉介入治疗场景。另外，还构建了代表 8 个髂股静脉介入治疗场景的 40 个问题调查。临床情况按介入阶段分类：介入前、介入中和介入后优化。30 名国际血管专家（每个调查各 15 名）匿名完成了调查工具。结果按适当性分类，采用中位数值，并分发给投票小组重新评估任何分歧。
专家共识认为，IVUS 的使用可能适用于评估髂动脉和股腘动脉闭塞的病因和斑块形态的介入前阶段。IVUS 在髂动脉和股腘动脉血运重建的大多数其他介入前场景中以及介入中和介入后优化阶段也被评为适当。IVUS 在所有介入阶段都被评为胫骨动脉的适当治疗方法。对于髂股静脉介入治疗，IVUS 在所有介入阶段都被评为适当。
在收集更多的前瞻性数据的同时，专家共识可以帮助定义外周 IVUS 在下肢动静脉介入治疗中可能具有价值的临床手术场景。
