Amputation After Endovascular Therapy With and Without Intravascular Ultrasound Guidance: A Nationwide Propensity Score–Matched Study

Abstract

Background: Intravascular ultrasound (IVUS) provides precise intravascular information during endovascular therapy (EVT). However, the clinical efficacy of IVUS in patients who undergo EVT remains unknown. The present study aimed to determine whether the use of IVUS-guided EVT is associated with better clinical outcomes in a real-world setting. Methods: Using the Japanese Diagnosis Procedure Combination administrative inpatient database from April 2014 to March 2019, we identified patients diagnosed with atherosclerosis of arteries of extremities and underwent EVT (percutaneous endovascular transluminal angioplasty and thrombectomy for extremities or percutaneous endovascular removal). Propensity score matching analysis was performed to compare outcomes between the patients who underwent IVUS on the same day as the first EVT intervention (IVUS group) and the others (non-IVUS group). The primary outcome was major and minor amputation for extremities within 12 months of the first EVT procedure. Secondary outcomes were bypass surgery, stent grafting, reintervention, all-cause death, readmission, and total hospitalization costs within 12 months of the first EVT procedure. Results: Among 85 649 eligible patients, 50 925 (59.5%) were IVUS group. After propensity score matching, the IVUS group had significantly lower incidence of 12-month amputation compared with the non-IVUS group (6.9% in the IVUS group versus 9.3% in the non-IVUS group; hazard ratio, 0.80 [95% CI, 0.72–0.89]). Compared with the non-IVUS group, the IVUS group showed a lower risk of bypass surgery and stent grafting and decreased total hospitalization costs, while a higher risk of reintervention and readmission. No significant differences in all-cause death were found between the 2 groups. Conclusions: In this retrospective study, IVUS-guided EVT was associated with a lower amputation risk than non-IVUS–guided EVT. Our findings should be interpreted carefully because of the limitations of an observational study using administrative data. Further studies are warranted to confirm whether IVUS-guided EVT leads to decreased amputations.

Impact of intravascular ultrasound‐guided endovascular therapy on periprocedural outcomes in patients with lower‐extremity artery disease

“…13 In fact, this study demonstrated that IVUS was used in 65.7% of cases, which was similar to the frequency reported by the Diagnosis Procedure Combination in Japan between 2014 and 2019. 14 In the current study, we reported the baseline characteristics and frequency of IVUS use by arterial regions, and our results may reflect the potential of IVUS use for contemporary AI-and FP-EVT. | 281 Furthermore, our results showed that IVUS was more frequently used in treatment with antirestenotic devices, including DES, DCB, and covered stents.…”

“…Better assessments using IVUS could potentially help physicians to select and manage superior procedural strategies and reduce the risks of amputation or major adverse limb events. 10,14 However, the reference vessel diameter measured by IVUS has been reported to be larger than that measured by angiography, and larger balloon selection might lead to POCs, such as peripheral embolism and vascular rupture. 18 In addition, it has been reported that complications increase with procedural time extension.…”

Use of Intravascular Ultrasound to Optimize Peripheral Vascular Interventions: How Do We Optimize Outcomes and Improve Uptake?

“…Fortunately, there has recently emerged data supporting the benefit of IVUS in lower extremity revascularization, and as such, this analysis is timely as this nascent field continues to grow. In this edition of Circulation: Cardiovascular Interventions, Setogawa et al 4 examine the characteristics and outcomes of patients undergoing endovascular therapy (EVT), stratified by the use of IVUS. This analysis uses a large Japanese administrative claims database with available procedural information for patients undergoing EVT from 2014 to 2019.…”

Drug-Coated Balloons With or Without Provisional Bare Metal Stenting in Femoropopliteal Disease: No Metal Left Behind?

“…The use of IVUS was associated with a lower incidence of 12-month amputation, as well as a lower risk of stent grafting and bypass surgery. 9 A recent consensus document was published outlining clinical areas where the use of peripheral IVUS would be appropriate. 10 Detection of residual stenosis, dissection detection, and determination of next therapeutic step were all given appropriate designations for the use of peripheral IVUS in the femoropopliteal segment.…”