Vessel Diameter Evaluated by Intravascular Ultrasound Versus Angiography

Abstract

Purpose: Although reference vessel diameter (RVD) is conveniently measured by angiography during femoropopliteal (FP) endovascular therapy (EVT) in clinical practice, angiography will potentially underestimate RVD. On the other hand, intravascular ultrasound (IVUS) can measure RVD precisely. The aim of this study was to reveal the difference between angiography- and IVUS-assessed RVD in patients undergoing FP-EVT for symptomatic peripheral artery disease (PAD). Methods: We analyzed a prospective and multicenter database including 1967 limbs of 1725 patients with symptomatic PAD undergoing IVUS-supported FP-EVT. The study outcome measure was the difference between IVUS- and angiography-assessed distal RVD ( ΔRVD), calculated as angiography-assessed RVD subtracted from IVUS-assessed RVD. The clinically important difference was defined as 1 mm or larger. Results: IVUS-assessed RVD was significantly larger than angiography-assessed RVD (6.0±1.0 mm vs 5.0±1.0 mm; p<0.001). Mean ΔRVD (IVUS- minus angiography-assessed RVD) was 0.98 mm (95% CI, 0.94–1.03 mm). ΔRVD was 1 mm or larger in 48.8% (46.5%–51.0%) of the whole population. Multivariate analysis demonstrated that small angiography-assessed RVD, angiography-assessed bilateral calcification, and history of stent implantation were significantly associated with an increasing risk of ΔRVD ≥1mm, whereas presence of chronic total occlusion (CTO) was significantly associated with a decreasing risk of ΔRVD ≥1 mm. Conclusion: The current study revealed the difference between angiography-assessed reference lumen diameter and IVUS-assessed reference EEM diameter of FP lesions. About half of population had ΔRVD ≥1 mm. IVUS-assessed RVD was more likely to be different by angiography in cases with small vessels, CTO, bilateral calcification, and history of stent implantation.

Vessel Patency and Associated Factors of Drug‐Coated Balloon for Femoropopliteal Lesion

“…It has been reported that there is a discrepancy in vessel diameter by approximately 1 mm between IVUS and angiography; this discrepancy is marked in small vessels. 25 The use of IVUS may provide adequate dilatation. 26 In addition to CTO and circumferential calcification, postprocedural IVUS‐measured minimal lumen area has been reported to be a significant predictor of restenosis after DCB.…”

Impact of postprocedural minimum lumen area on clinical outcome after femoropopliteal drug-eluting stent implantation

“…The vessel diameter measured using IVUS is generally larger than that measured in angiography. 22 Consequently, IVUS use would be associated with the use of larger balloons, resulting in aneurysmal degeneration formation. Although it is still unclear whether aneurysmal degeneration after FP-DES implantation affects clinical events, a case of aneurysmal degeneration progression has been reported, 23 and long-term follow-up is warranted.…”

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

“…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. 12 The current study revealed a lower rate of major amputation, a higher rate of vessel rupture, and longer operation time in the IVUS group than in the non-IVUS group.…”