C-22 | Intravascular Ultrasonography Versus Angiography-Guided Endovascular Interventions in Peripheral Arterial Disease: A Systematic Review and Meta-Analysis

Intravascular Ultrasonography (IVUS) is a reliable adjunctive imaging modality for endovascular interventions in peripheral arterial disease (PAD) and enables improved treatment planning and optimization of the procedure.We conducted a meta-analysis to compare clinical outcomes of IVUS-guided interventions with angiography in PAD. 17 studies (1 RCT and 16 observational studies) were identified through a systematic search of PubMed and Embase till November 2023. Primary outcome was restenosis rate while secondary outcomes included target lesion revascularization (TLR), major amputation, mortality, and myocardial infarction (MI). We employed a random-effects model and the Mantel-Haenszel method to calculate odds ratios (OR) for dichotomous outcomes with a 95% CI. On pooled analysis, adjunctive IVUS showed a statistically significant improvement in restenosis rate (OR: 0.57, 95% CI [0.38; 0.85] p: 0.005), major amputation events (OR: 0.73, 95% CI [0.65; 0.82] p< 0.0001) and mortality rate (OR: 0.89, 95% CI [0.83; 0.95] p: 0.0005). There was a statistically insignificant decrease in the risk of MI (OR: 0.76, 95% CI [0.40; 1.46], P = 0.41) and TLR events (OR: 0.68, 95% CI [0.45; 1.03] p: 0.07) in the IVUS group as compared to the angiography group. IVUS-guided endovascular interventions hold promise for improving clinical outcomes, including restenosis, TLR, major amputation, and mortality, in comparison to angiography alone. However, further clinical trials and observational studies are crucial to validate the utility of this technology in clinical practice