Lower extremity revascularization is an important medical procedure aimed at restoring blood flow to the legs and feet of patients with peripheral arterial disease (PAD) and deep venous pathology. These conditions affect millions globally and can lead to severe complications such as intense pain, non-healing wounds, and even the potential loss of limbs if left unaddressed. While angiography remains the primary imaging method in revascularization, it is not without limitations. Intravascular ultrasound (IVUS) emerges as a minimally invasive technique that provides real-time internal views of blood vessels, offering comprehensive insights into the vessel wall, plaque composition, and blood flow characteristics. This information is critical for more accurate diagnoses and designing effective treatment plans.

An expert consensus roundtable convened by the Society for Cardiovascular Angiography & Interventions (SCAI, Washington, DC, USA) focused on the pressing challenges in diagnosing and treating lower extremity revascularization. The discussion brought together seasoned professionals from interventional cardiology, interventional radiology, and vascular surgery to assess the current difficulties, knowledge gaps, and the promising role of IVUS in surmounting these challenges. During the roundtable, the participants highlighted the potential of IVUS in guiding revascularization procedures, like angioplasty and stenting, pointing to its capability to enhance patient outcomes significantly. However, the experts recognized the need for additional research and evidence to advocate for IVUS’s integration into everyday clinical settings. The roundtable wrapped up with a commitment towards continued interdisciplinary cooperation and knowledge exchange among physicians. There was a consensus on the need for established treatment standards, formal training programs, and globally recognized quality metrics to improve patient care in this field.

"Improvements in outcomes following peripheral vascular intervention have lagged compared to other endovascular treatments, such as percutaneous coronary intervention. Both clinical experience and evidence support the greater use of peripheral IVUS to reduce adverse events and extend the patency of our lower extremity revascularization procedures. By gathering experts from different specialties, we aimed to foster collaboration and exchange ideas to improve patient care for peripheral IVUS," said Eric A. Secemsky, MD, MSc, FSCAI, lead author of the proceedings document that was released in various journals. "The roundtable provided a unique opportunity to identify knowledge gaps and discuss how IVUS can enhance our understanding and treatment of peripheral arterial and deep venous pathology."

"The insights gained from this roundtable will help shape future research, training, and clinical guidelines in the field of lower extremity revascularization," Secemsky added. "By leveraging the power of IVUS, we can improve our ability to diagnose and treat patients, ultimately leading to better outcomes and quality of life." 

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