Appropriate Use of IVUS in Lower Extremity Interventions: Expert Consensus

Dr. Secemsky practices at BIDMC in Boston. His passions are pulmonary embolism intervention and intravascular ultrasound (IVUS) for peripheral vascular disease. He began using IVUS for coronary interventions, and then began incorporating it in arterial and venous peripheral interventions. The goal is to make procedures durable in the endovascular world, and IVUS is key for that.

In the coronaries, there is a standardized way that all cardiologists use IVUS for. First, they cross the lesion with the wire, then use IVUS to measure lesion length and vessel diameter for stent sizing. They also evaluate plaque composition, which informs whether to use a plaque modifying device before stenting. They then balloon, stent, and use IVUS again to evaluate stent position and check for dissections. Dr. Secemsky measures an arterial lumen by identifying the 3 layers of the vessel wall, and finding the black stripe behind the intima, which corresponds to the elastic membrane.

Dr. Secemsky tells us about a consensus article he published in the Journal of the American College of Cardiology. He collaborated with some colleagues to form a 12 person steering committee composed of interventional cardiology, interventional radiology, vascular surgery and vascular medicine specialists. The goal was to consolidate information from all these specialties to provide a single standardized document. This document can be used for those wanting to incorporate IVUS into their practice, but don’t know where to begin. They established levels of evidence regarding where IVUS is most appropriate. They found that tibial arterial intervention has the highest support for use of IVUS across specialties. Furthermore, they established that the best practice for IVUS is to use it three times per case, for pre-intervention, middle-run and post-run. Using IVUS is safe, and offers so much information to make case a more efficient. In addition, you cut down on device utilization, contrast use and radiation exposure, while improving patient outcomes by getting better luminal gain and improved durability of your intervention.