Use of intravascular ultrasound (IVUS) in lower limb angioplasty: A single centre experience

Type of Research: Retrospective observational study of IVUS-guided lower limb angioplasty database in a multi-ethnic Asian population. Key Findings: Below-the-knee arterial diameters were significantly smaller than European reference values, while above-the-knee arteries were larger than local RVDs. Demographic and comorbidity factors, such as race, gender, smoking status, coronary artery disease, diabetes, and hypertension, significantly influenced arterial size. Take home message: IVUS is essential for accurately assessing arterial diameters and guiding lower limb angioplasty in diverse populations, with demographic and comorbidity factors impacting treatment decisions. Digital subtraction angiography (DSA), the gold standard for endovascular imaging, has limitations in precision and safety. Intravascular ultrasound (IVUS) provides greater accuracy with detailed cross-sectional images, particularly useful for guiding percutaneous revascularisation. However, most IVUS data focuses on coronary interventions, with limited research on its application in lower limb procedures, especially in Asian populations. A retrospective observational study of IVUS-guided lower limb angioplasty cases at Sengkang General Hospital, Singapore, analysed data from 65 Asian patients between January 2022 and June 2023. Assessing mean arterial diameters(MAD) and comparing them with reference vessel diameters (RVD) from European populations, locally derived RVDs, and post-intervention measurements. A multivariate analysis examined the relationships between arterial diameters and factors such as demographics and comorbidities. Significantly smaller artery diameters for below-the-knee (BTK) vessels in the study population than in Europe. The anterior tibial artery measured 3.25 mm vs. 3.37 mm (p = .031), the peroneal artery 2.74 mm vs. 3.03 mm (p = .001), and the posterior tibial artery 2.79 mm vs. 3.10 mm (p < .001). Above the knee, arteries were larger than local RVD, with the common femoral artery (CFA) at 7.8 mm vs. 6 mm (p < .001), the popliteal artery at 5.43 mm vs. 4 mm (p = .043) and the superficial femoral artery (SFA) at 6.38 mm vs. 5 mm (p = .145). Multivariate analysis revealed associations between arterial diameters and factors like race, gender, smoking status, coronary artery disease, diabetes, and hypertension. Despite a small sample size, this study suggests that demographic factors may influence arterial size, impacting clinical decision-making and outcomes in peripheral arterial intervention. This highlights the importance of incorporating IVUS into routine practice for lower limb angioplasty in diverse populations. Further research with larger samples is needed to expand on these findings.