Multidisciplinary experts advocate broader adoption of IVUS in peripheral interventions

A group of multidisciplinary cardiovascular specialists from prominent medical societies have issued a joint expert opinion on the advantages of intravascular ultrasound (IVUS) use in peripheral arterial and deep venous interventions compared with using angiography alone.

The use of IVUS in peripheral interventions remains low despite growing clinical evidence

The report was published simultaneously in the Journal of the Society for Cardiovascular Angiography and Interventions (JSCAI), the Journal of Vascular and Interventional Radiology (JVIR), and the Journal of Vascular Surgery-Vascular Insights (JVS-Vascular Insights).

It reviews the current evidence base and clinical experience for IVUS-guided interventions by a roundtable panel consisting of 15 physicians from six cardiovascular specialty societies. The goals of the panel discussion were to assess the current state of IVUS utilization in lower extremity revascularization, identify evidence gaps, and determine how IVUS can improve the care of patients with peripheral arterial and deep venous pathology.

Lead author Eric A. Secemsky, Interventional Cardiologist at Beth Israel Deaconess Medical Center and Assistant Professor of Medicine at Harvard Medical School, Boston USA, said: “While the panel acknowledges that additional clinical evidence is critical to advancing the utilization of IVUS, the current data reviewed as part of this expert roundtable supports greater use of IVUS in contemporary clinical practice. The panel looks forward to working with our collective societies to increase access to training with IVUS, support strong reimbursement to allow for wider adoption, and work to incorporate IVUS into clinical guidelines.”

Peripheral arterial disease (PAD) and deep venous disease affect nearly 200 million people worldwide, including approximately 40 to 45 million Americans. Minimally invasive treatments for peripheral vascular disease (PVD) are increasingly common, but traditional imaging techniques like angiography have limitations, including 2-dimensional projections of 3-dimensional vasculature, which can complicate diagnosis and intraprocedural optimization.

The panel acknowledged that IVUS utilization remains low despite growing data and clinical experience demonstrating the benefits of IVUS in contemporary peripheral interventions. Compared with angiography alone, the document highlights the advantages of IVUS including identification of plaque burden and morphology, lesion characteristics as well as stent sizing and positioning which translate into improvements in procedural safety and long-term patient outcomes.

There was agreement among experts that the main evidence gap for peripheral arterial use was determining if uptake in practice can improve procedural success. Importantly, the authors also noted that the reductions in radiation exposure in an IVUS-guided procedure have significant value for both operative staff and patients that may on its own be sufficient to justify use. Besides the positive impact on radiation safety and patient contrast load, IVUS may also play an important role in the use of novel technologies, like ultrasound renal denervation.

The committee also identified several barriers to increased IVUS use including limitations with access to technology and training, restrictive reimbursement, and perceptions around added time. The joint multidisciplinary expert opinion is timed to recent policy proposals by The Society for Cardiovascular Angiography and Interventions (SCAI), American College of Cardiology (ACC), Society of Interventional Radiology (SIR), Society for Vascular Surgery (SVS) and Outpatient Endovascular and Interventional Society (OEIS) for broader reimbursement of IVUS in modern interventional practice.

Chris Landon, Business Leader of Image Guided Therapy Devices at Philips said: “IVUS is a technology that has demonstrated an ability to both support safer procedures for patients and procedural staff alike including reductions in radiation exposure. As the global leader in IVUS solutions, we are grateful for the rigorous multidisciplinary approach to developing expert consensus on the value of IVUS and we look forward to working with all stakeholders to standardize the use of IVUS and reduce the barriers preventing utilization.”
MB Bureau