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Home > Vascular Annual Meeting^® > PVSS20. Evaluation of Peripheral Atherosclerosis: Angiography...

PVSS20. Evaluation of Peripheral Atherosclerosis: Angiography vs. Intravascular Ultrasound

Zachary M. Arthurs, MD; Paul D. Bishop, MS; Lindsay Feiten, BS; Matthew J. Eagleton, MD; Daniel G. Clair, MD; Vikram S. Kashyap, MD
Cleveland Clinic Foundation, Cleveland, OH

OBJECTIVES: Angiography remains a critical component for diagnostic imaging and therapeutic intervention in peripheral arterial disease (PAD). However, inherent limitations exist prompting this study to compare angiography to corresponding intravascular ultrasound (IVUS) imaging in PAD.

METHODS: From 2004-2008, patients undergoing angiography for PAD (n=93) were recruited in a prospective observational analysis. At the time of angiography, diseased lower extremities were interrogated via a 10-cm IVUS pullback with registration points. IVUS data were analyzed with radiofrequency techniques for vessel and lumen diameter, plaque volume, plaque composition, and cross-sectional area (VH™, Volcano Corp). Similarly, vascular surgeons (n=3) blinded to the IVUS data graded corresponding angiographic images according to vessel diameter, degree of stenosis, degree of calcification, and extent of eccentricity. Statistical analyses of matched IVUS/angiograms were performed utilizing SPSS 16.0 (Chicago, IL).

RESULTS: The distribution of demographic and risk variables were typical for PAD: 54% male, 96% hypertension, 78% hyperlipidemia, 44% diabetic, 87% tobacco history, 65% coronary artery disease, and 8% end-stage renal disease. Symptoms precipitating the angiographic evaluation included claudication (53%), rest pain (18%), and tissue loss (29%). Angiographic and IVUS interpretation were similar for luminal diameters, but angiography underestimated vessel diameter (5.2±0.8 vs. 7.0±0.7 mm, p<0.05). There was a significant correlation for stenosis determination (r=0.655) utilizing the two-dimensional diameter method; however, angiography underestimated vessel area stenosis by 10% (95% confidence interval=0.3-21%, p<0.05). Concentricity and calcification grading between angiography and IVUS were discordant. Additional data obtainable by IVUS only included plaque morphology (fibrous 63%, necrotic 14%, calcific 9%) and plaque volume.

CONCLUSIONS: In the evaluation of peripheral arterial disease, angiography provides accurate luminal diameter. Actual vessel diameter, degree of stenosis, and interpretation of plaque morphology are discordant from IVUS data. These data imply that the addition of IVUS may aid in the performance and durability of endovascular therapies.

AUTHOR DISCLOSURES: Z.M. Arthurs, None; P.D. Bishop, Volcano Corp; L. Feiten, None; M.J. Eagleton, None; D.G. Clair, None; V.S. Kashyap, None.