An Evaluation of the Utility of Intravascular Ultrasound in an Endovascular Practice

Intravascular ultrasound (IVUS) has been shown to be superior to arteriography for measuring luminal stenosis and characterizing plaque morphology and content. However, IVUS has not been routinely adopted during endovascular interventions, which may be due to the added time, expense, and general perception of the efficacy of arteriography. The authors performed a prospective study to assess the utility of IVUS in a typical vascular surgery practice consisting of open and catheter-based procedures. Over a recent 7-month period, IVUS was used by one vascular surgeon during 21 procedures in 20 patients at the Emory University affiliated hospitals. The procedures included 11 cases of iliac artery angioplasty or stenting (with or without concomitant infrainguinal reconstruction), six diagnostic iliac arteriograms, three cases of supraaortic trunk stenting, and an innominate arteriogram. Useful information given by IVUS was noted. Estimates of the percent cross-sectional area stenoses of 19 lesions were made by IVUS and arteriography for comparison. In 6 of 21 (29%) of cases, information from IVUS changed or facilitated intraoperative plans that were made on the basis of arteriography. Three modified procedures included redilating an underexpanded iliac artery stent, dilating a fold in an iliac artery stent-graft, and stenting an iliac artery stenosis, all of which were not detected with arteriography. In three additional cases, IVUS proved to be valuable for precisely positioning stents in the supraaortic vessels when intraoperative arteriography was suboptimal. The mean percent cross-sectional area of the stenoses was not significantly different when measured by IVUS (43.7%) or by arteriography (49.1%) (p=0.42). IVUS is especially advantageous during complicated stenting procedures and supraaortic revascularization and should be available to the surgeon who performs catheter-based interventions. Diagnostic arteriography will detect most hemodynamically significant lesions, but IVUS can be used to clarify the anatomy in selected cases.