A Comparison of Angiography Versus Intravascular Ultrasound In The Treatment Of Peripheral Arterial Disease

Peripheral Arterial Disease is a growing epidemic throughout the United States. It is estimated that 8 to 12 million Americans currently suffer from PAD, a disease of the circulatory system that limits blood flow to your hands and feet. This limited blood flow is due to the narrowing of the arteries that supply blood throughout your body and can disrupt the balance of the nerves and tissues that make up your extremities. If left untreated, it can cause irreparable, life- threatening damage that may result in amputation of the diseased limb. Although the mechanism of PAD is known and well understood, different treatment options are still being researched and evaluated in order to fully understand which is the most effective and efficient for each clinical presentation. The least invasive treatment options are lifestyle changes, including the implementation of exercise regimes or medical therapy in an effort to control the primary causes of PAD. However, these may be met with limited success, and greater more invasive intervention may be necessary. Surgical treatment options usually include the use of a long wire to reach the obstructed region of the blood vessel and remove the plaque. In rare cases, it may be necessary to use a man- made artery in order to create an alternate route for blood to flow around the occluded segment. All of these surgical interventions require the use of an imaging technique in order to both navigate through the arteries to the obstructed segment and view the plaque accumulation inside the vessel. 3 Angiography has long been considered to be the best method for navigating through the different arteries of the leg, even though its ability to view the accumulated plaque is adequate at best. In recent years, intravascular ultrasound has shown to be capable of providing more accurate details regarding the vessel lumen, plaque shape, and composition as compared to angiography. A greater understanding of these components aids in both the diagnostic and treatment process. Intervening physicians are able to gain a greater understanding of where the obstruction is located and how bad it is, which allows them to better decide if intervention is necessary. In addition, in the event that intervention is warranted, greater knowledge regarding the plaque shape and composition allows them to choose the interventional technique that will produce the best outcome for the patient. The solution to the current lack of information most likely comes in the form of using IVUS in adjunct with angiography during interventional procedures. This would allow the intervening physician to both navigate to the right location and view the extent of the plaque accumulation. IVUS, however, is currently limited by its cost of implementation, which can range anywhere from $70,000- $120,000 for a basic system, in addition to a $600 disposable catheter tip per patient. As research continues to develop, new solutions and technological advancements may help lower the costs of the existing technology