Purpose: To assess the utility of intravascular ultrasound (IVUS) during below-the-knee (BTK) interventions for patients with chronic limb-threatening ischemia (CLTI). Materials and Methods: This retrospective single-center study included 216 symptomatic patients (mean age 74.2±9.5 years; 167 men) with CLTI and BTK steno-occlusive disease who underwent successful balloon angioplasty between January 2016 and August 2018. Data from 88 vessels (58 patients) treated with IVUS-guided procedures were compared with corresponding values from 242 vessels (158 patients) treated with angiography-guided procedures. The primary outcomes included procedure-related variables of balloon size, contrast dose, and complication rates, as well as changes in ankle-brachial index (ABI) and skin perfusion pressure (SPP). Secondary outcomes included IVUS determination of vessel size, wire route, and calcification severity, as well as technical success and clinically-driven target lesion revascularization (TLR), limb salvage, and wound healing rates in the Rutherford category 5/6 patients as evaluated by propensity score matching analysis. Results: The patient and lesion characteristics were similar in both groups. The mean balloon size for IVUS-guided procedures was significantly larger (2.45±0.4 mm) compared with that for angiography-guided procedures (2.23±0.4 mm; p<0.001). The technical success (p=0.56) and complication rates (p=0.16) were similar between the groups. The postprocedure dorsal and plantar SPP and change in dorsal SPP improved more in the IVUS-guided group (p<0.001, p=0.015, and p=0.02, respectively). The IVUS-guided group had a significantly better wound healing rate than the angiography-guided group (p=0.006), although the freedom from TLR and limb salvage rates were similar between the groups (p=0.16 and p>0.99, respectively). Conclusion: IVUS-guided interventions for BTK lesions were safe and effective in accurately assessing the lesions. The results suggest that IVUS guidance of endovascular procedures has the potential to influence better clinical outcomes than angiography-guided angioplasty.
To assess the safety and efficacy of routine use of ultrasound-guided puncture and the use of vascular closure device (VCD) in patients undergoing endovascular therapy (EVT) through femoral access. This was a single-center, non-randomized clinical study that enrolled 513 patients undergoing EVT via femoral artery access in which hemostasis was achieved using VCDs (406-patient EXOSEAL arm and 107-patient PROGLIDE arm). All cases were performed by routine use of ultrasound-guided access. The primary endpoint was the achievement of hemostasis without periprocedural and 30-day incidence of major or minor access site-related complications. The primary endpoint was achieved in 91.6 % of the cases (470/513) with a higher success rate in the EXOSEAL arm (93.6). Major complications were observed in 5 patients (0.9 %) in total cohort and 3 patients (0.7 %) treated with EXOSEAL arm vs. 2 patients (1.8 %) with PROGLIDE arm (p = 0.32). Combined treatment two VCDs with the routine ultrasound guidance access for patients who underwent the EVT procedure showed high efficacy and safety outcomes.
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