Analysis Of Application Of Intravascular Ultrasound In Lower Limb Artery Endovascular Treatment

Objective: To compare the clinical effects of lower limb artery endovascular treatment(EVT)guided by intravascular ultrasound(IVUS)and Digital Subtraction Angiography(DSA).To explore the application value of IVUS in lower limb artery EVT.Methods: This study is a single-center,non-randomized,controlled study.Patients who were admitted to the Vascular Surgery Department of The Second Xiangya Hospital of Central South University from July 2019 to September 2021 and received endovascular treatment of lower limbs were selected.Patients are divided into IVUS+DSA group and DSA group according to the imaging equipment used to guide them during endovascular treatment(DSA group only use DSA guidance,IVUS group use DSA+IVUS guidance).The proportion of residual stenosis and grade of dissection detected by IVUS and DSA were compared within the IVUS group after vascular preparation.The differences in operation duration,postoperative walking distance and ankle-brachial index improvement after treatment were compared between the DSA group and IVUS group,and the differences in postoperative long-term survival rate,vascular patency rate and serious complications were compared between the two groups.The patients were divided into TASCⅢ B,TASCⅢ C and TASCⅢ D groups according to TASCⅢ and the improvement of walking distance,ankle-brachial index and long-term patency rate of affected limbs before and after treatment under the guidance of DSA and IVUS were compared in each group.Results: A total of 100 patients(50 cases in DSA group and 50 cases in IVUS group)who underwent endovascular treatment of lower limbs were enrolled in this study,meeting the inclusion criteria and completing follow-up.Follow-up time was(22.7±6.3)months in the DSA group and(19.6±8.5)months in the IVUS group.The rate of residual stenosis detected by DSA and IVUS after vascular preparation was(48.8±24.9)%vs.(79.9±9.8)%.The degree of dissection found in the two groups after vascular preparation was(3±1)vs.(4±1),with statistically significant differences(P <0.05).There was no significant difference in ABI improvement between the DSA group and IVUS group on the first day after surgery(P = 0.1).In postoperative follow-up,the postoperative walking distance of the two groups was(528.2±381.2)m vs(839.8±680.4)m and the increased walking distance before and after surgery was(435.9±354.6m)vs(707.2±644.3)m(P <0.05).The survival rates of DSA group and IVUS group were 98% and 100%,respectively.There was no significant difference in the long-term patency rate of lower limb arteries.There was1 amputation case in DSA group and no amputation in IVUS group.According to different TASCⅢ classification,the long-term patency rate of TASCⅢ C IVUS group was 93.7%(15/16)higher than that of DSA group 83.3%(10/12),and the difference was statistically significant(P<0.05).There was no significant difference between the other two groups.Conlcusions: IVUS may be more sensitive than DSA in detecting residual stenosis and grading of dissection degree after vascular preparation in endovascular treatment of lower limbs.Compared with DSA-guided EVT alone,IVUS has a better effect on improving the postoperative walking distance and the walking distance before and after surgery in the guidance of intravascular therapy of lower limbs.IVUS application in intravascular therapy of lower limbs can improve the longterm patency rate of lower limb vessels in TASCⅢ C patients.Whether IVUS guidance can further improve prognosis still needs to be observed in clinical randomized controlled studies.