Intravascular ultrasound adoption for CLTI revascularization is primarily hindered by cost (69.5%), longer procedural time (47.6%), and lack of randomized data (39.0%) among 105 surveyed operators.
Cross-Sectional (n=105)
Yes
A multidisciplinary survey highlights that cost, procedural time, and lack of randomized data are the main barriers to IVUS use in CLTI revascularization, though operators show strong willingness to participate in future RCTs.
BACKGROUND: Intravascular ultrasound (IVUS) may be beneficial for guiding endovascular revascularization in patients with chronic limb-threatening ischemia (CLTI); however, its use remains limited. METHODS: We surveyed interventional radiologists, vascular surgeons, and interventional cardiologists in the United States, Canada, and the United Kingdom using a 13-question, anonymous online questionnaire to evaluate clinical equipoise, willingness to randomize, and opinions and perceptions regarding IVUS use in patients with CLTI undergoing endovascular revascularization. RESULTS: A total of 105 operators (5.7% response rate) participated in the survey: 42 interventional radiologists, 40 vascular surgeons and 23 interventional cardiologists. Operators indicated the main obstacles to adopting or expanding IVUS for endovascular revascularization were cost or lack of reimbursement (69.5%), concerns about longer procedural time (47.6%), and the absence of randomized data supporting its benefit (39.0%). Overall, 80.0% of operators agreed that a large, multicenter, randomized trial was required, and 77.1% were willing to randomize patients in such a trial. CONCLUSION: In this multidisciplinary survey, the identified barriers for IVUS use in CLTI revascularization were cost/non-reimbursement, increased procedural time, and lack of randomized evidence. Given respondents' clinical equipoise and willingness to randomize, large randomized controlled trials are needed to inform clinical practice.
d’Entremont et al. (Mon,) conducted a cross-sectional in Chronic limb-threatening ischemia (n=105). Intravascular ultrasound (IVUS) was evaluated on Clinical equipoise, willingness to randomize, and opinions and perceptions regarding IVUS use. Intravascular ultrasound adoption for CLTI revascularization is primarily hindered by cost (69.5%), longer procedural time (47.6%), and lack of randomized data (39.0%) among 105 surveyed operators.