Intravascular ultrasound (IVUS)-guided angioplasty for femoropopliteal (FP) peripheral artery disease: A Meta-analysis of its mid-term efficacy.

INTRODUCTION: Intravascular ultrasound (IVUS)-guided femoropopliteal (FP) angioplasty has emerged as a promising imaging-guided strategy in clinical practice. However, current evidence remains heterogeneous, and recently, two randomized controlled trials (RCTs) have provided additional insights into its efficacy. This meta-analysis aims to reevaluate the efficacy of IVUS-guided angioplasty for FP lesions and to better clarify its clinical impact. METHODS: Four databases were systematically searched for studies comparing IVUS-guided angioplasty to angiography-only in FP lesions. Study quality was assessed using the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale. Meta-analysis was performed using an inverse-variance random-effects model using Rstudio version 2024.09.01. RESULTS: Six high quality studies were included (n = 1544 patients). The risk for primary patency and freedom of clinically driven-target lesion revascularization(cd-TLR) at 1 year was significantly higher in the IVUS-guided group compared to the angiography group (RR 1.27 (95%CI 1.13-1.42, I2 = 58.6%) and RR 1.10 (95%CI 1.01-1.20, I2 = 56.8%), respectively), but no significant difference was observed in freedom of amputation and mortality (RR 1.00 (95%CI 0.98-1.01, I2 = 0%) and RR 1.06 (95%CI 0.67-1.70, I2 = 0%), respectively). CONCLUSION: IVUS-guided FP angioplasty improves primary patency and reduced cd-TLR rates. Further studies with longer follow-up duration should be the research focus in order to understand the long-term efficacy.