Feasibility and impact of extra‐vascular ultrasound‐guided endovascular treatment for infrapopliteal artery occlusive disease

Abstract

Purpose: This study aimed to examine the feasibility and impact of extra-vascular ultrasound (EVUS)-guided intervention for infrapopliteal (IP) artery occlusive disease.Materials and Methods: A retrospective analysis was performed using data collected from patients who underwent endovascular treatment (EVT) for IP artery occlusive disease between January 2018 and December 2020 at our institution. A total of 63 consecutive de novoocclusive lesions were compared according to the recanalization method utilized. Propensity score matching analysis was performed to compare the clinical outcomes of the methods utilized. The prognostic value was analyzed based on the technical success rate, distal puncture rate, radiation exposure, amount of contrast media, postprocedural skin perfusion pressure (SPP), and procedural complication rate.Results: Eighteen matched pairs of patients were analyzed using propensity scorematched analysis. Radiation exposure was significantly lower in the EVUS-guided group than in the angio-guided group, with 135 and 287 mGy (p = 0.04) exposure on average, respectively. There were no significant differences between the two groups in terms of technical success rate, distal puncture rate, the amount of contrast media, postprocedural SPP, and procedural complication rate. Conclusion: EVUS-guided EVT for IP occlusive disease achieved a feasible technical success rate and significantly reduced radiation exposure. K E Y W O R D S extra-vascular ultrasound, infrapopliteal, occlusive disease 1 | INTRODUCTION Endovascular treatment (EVT) for infrapopliteal (IP) artery occlusive disease is sometimes technically challenging due to the small vessel diameter, long lesion length, and severe calcification. If an antegrade guidewire fails to advance into the distal true lumen, a retrograde approach might be considered to achieve successful revascularization. Previous studies have demonstrated the success rate of interventions forIP occlusive disease to be approximately 80%, even when using a retrograde approach. 1,2 Extra-vascular ultrasound (EVUS) is not only a major diagnostic tool for vascular diseases in general but is also very helpful as an imaging modality during recanalization procedures.