How IVUS Changed My Intervention
Advanced Cardiac & Vascular Centers, Las Vegas, Nevada
During Thursday’s “Diagnosis and Imaging in CLTI” session, George Pliagas, MD, FACS, FRCSC, from Advanced Cardiac & Vascular Centers in Las Vegas, Nevada, shared how intravascular ultrasound (IVUS) has reshaped his approach to treating peripheral vascular disease, replacing guesswork with data-driven precision and delivering measurably better patient outcomes.
Dr Pliagas referenced studies that indicate angiography routinely underestimates lesion length by up to 3 mm and often misjudges the proximal and distal extents of disease by as much as 2 to 5 cm. These miscalculations can result in poorly sized treatment devices and missed disease segments, potentially contributing to postprocedural complications such as thrombosis or restenosis.
IVUS provides real-time, 360° cross-sectional imaging of the vascular lumen and wall, enabling more accurate identification of the full extent and complexity of lesions. According to Dr. Pliagas, IVUS not only enhances vessel sizing precision but also uncovers subtle features, such as flow-limiting dissections, calcium distribution, and thrombus morphology, that are critical for effective intervention.
To underscore the benefits of IVUS-guided interventions, Dr. Pliagas cited several studies, including a retrospective analysis of 43 patients with PAD comparing angiographic and IVUS measurements. The findings confirmed that angiographic imaging consistently underestimated vessel diameters, while IVUS provided a more accurate assessment of the vascular lumen. The use of IVUS ultimately contributed to better procedural planning and improved endovascular outcomes.
Looking ahead, Dr. Pliagas referenced innovations on the horizon, such as multimodal IVUS fusion imaging, contrast-enhanced IVUS, and AI-assisted interpretation, which promise to expand the utility of IVUS in vascular care even further.
