PMID- 36944390 OWN - NLM STAT- MEDLINE DCOM- 20230626 LR - 20231124 IS - 1097-6809 (Electronic) IS - 0741-5214 (Linking) VI - 78 IP - 1 DP - 2023 Jul TI - Trends and outcomes associated with intravascular ultrasound use during femoropopliteal revascularization in the Vascular Quality Initiative. PG - 209-216.e1 LID - S0741-5214(23)00473-1 [pii] LID - 10.1016/j.jvs.2023.03.028 [doi] AB - OBJECTIVE: Intravascular ultrasound (IVUS) use in lower extremity interventions is growing in popularity owing to its imaging in the axial plane, superior detail in imaging lesion characteristics, and its enhanced ability to delineate lesion severity and extent compared with catheter angiograms. However, there are conflicting data regarding whether IVUS affects outcomes. The purpose of this study was to assess the effect associated with IVUS implementation in femoropopliteal interventions. METHODS: This retrospective cohort study used Vascular Quality Initiative data. Patients undergoing an index endovascular femoropopliteal revascularization from 2016 to 2021 were included. Patients were differentiated by whether or not IVUS was used to assess the femoropopliteal segment during intervention (no IVUS, IVUS). Propensity score matching, based on preoperative demographics and measures of disease severity was used. Primary outcomes were major amputation-free survival (AFS), femoropopliteal reintervention-free survival (RFS), and primarily patent survival (PPS) at 12 months. RESULTS: IVUS use grew steadily throughout the study period, comprising 0.6% of interventions in 2016 and increasing to 8.2% of interventions by 2021; growth was most dramatic in ambulatory surgical center or office-based laboratory settings where IVUS use grew from 4.4% to 43% to 47% of interventions. In unmatched cohorts, patients receiving interventions using IVUS tended to have lower prevalence of multiple cardiovascular comorbidities (eg, congestive heart failure, hypertension, diabetes, and dialysis dependence) and presented more often with claudication and less often with chronic limb-threatening ischemia (CLTI). Intraoperatively, IVUS was used more often in complex femoropopliteal lesions (Transatlantic Intersociety grade D vs A), and more often in conjunction with stenting and/or atherectomy. IVUS use was associated with improved AFS, but similar RFS and PPS at 12 months. However, in multivariable analysis IVUS was not associated with any of the primary outcomes independently; rather, all outcomes were influenced primarily by CLTI, dialysis dependence, and prior major amputation status; technical outcomes (ie, RFS and PPS loss) were further driven by complexity of lesion (worse in Transatlantic Intersociety grade D vs A lesions) and treatment setting (ie, ambulatory surgical center or office-based laboratory setting associated with increased hazard for RFS and PPS loss). CONCLUSIONS: IVUS implementation in femoropopliteal interventions is growing, with rapid adoption among interventions in ambulatory surgical centers and office-based laboratories. IVUS was not associated with an effect on technical outcomes at 12 months; improvement in major AFS was observed; however, multivariable analysis suggests this finding may be an effect of confounding by multiple factors highly associated with IVUS use, namely, in patients with lower prevalence of CLTI, dialysis dependence, and prior major amputations, thus conveying baseline lower risk for major amputation and death. CI - Copyright (c) 2023 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. FAU - Smith, Justin A AU - Smith JA AD - Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH. Electronic address: Justin.smith@uhhospitals.org. FAU - Yang, Lucy AU - Yang L AD - Case Western Reserve University School of Medicine, Cleveland, OH. FAU - Chen, Lin AU - Chen L AD - Case Western Reserve University School of Medicine, Cleveland, OH. FAU - Kumins, Norman AU - Kumins N AD - Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH. FAU - Cho, Jae S AU - Cho JS AD - Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH. FAU - Harth, Karem AU - Harth K AD - Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH. FAU - Wong, Virginia AU - Wong V AD - Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH. FAU - Kashyap, Vikram AU - Kashyap V AD - Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI. FAU - Colvard, Benjamin AU - Colvard B AD - Division of Vascular Surgery and Endovascular Therapy, Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH. LA - eng PT - Journal Article DEP - 20230320 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 SB - IM MH - Humans MH - *Peripheral Arterial Disease/diagnostic imaging/therapy MH - Retrospective Studies MH - Risk Factors MH - Ischemia/diagnostic imaging/therapy MH - Treatment Outcome MH - *Endovascular Procedures/adverse effects MH - Limb Salvage MH - Ultrasonography, Interventional MH - Vascular Patency OTO - NOTNLM OT - Femoropopliteal disease OT - Intravascular ultrasound OT - Peripheral vascular intervention OT - Reintervention EDAT- 2023/03/22 06:00 MHDA- 2023/06/26 06:41 CRDT- 2023/03/21 20:15 PHST- 2022/11/11 00:00 [received] PHST- 2023/03/12 00:00 [revised] PHST- 2023/03/13 00:00 [accepted] PHST- 2023/06/26 06:41 [medline] PHST- 2023/03/22 06:00 [pubmed] PHST- 2023/03/21 20:15 [entrez] AID - S0741-5214(23)00473-1 [pii] AID - 10.1016/j.jvs.2023.03.028 [doi] PST - ppublish SO - J Vasc Surg. 2023 Jul;78(1):209-216.e1. doi: 10.1016/j.jvs.2023.03.028. Epub 2023 Mar 20.