Saritphat Orrapin
Current Position
Medical instructor in Vascular Surgery Division, Department of Surgery, Faculty of Medicine, Thammasat University Hospital
Vascular Surgery Division, Department of Surgery, Faculty of Medicine, Thammasat University
Peripheral Artery Session

Topic: Intravascular imaging guidance to achieving the best target arterial path in chronic limb-threatening ischemia


In endovascular era, intravascular imaging, including intravascular ultrasound (IVUS) and optical coherence tomography (OCT) has provided a 360-degree imaging of intraluminal structure which is a key to detecting a challenges lesion before treatment and also ensure the best vessel preparation of endovascular therapy (EVT).

To improve treatment outcomes of EVT, real-time intravascular imaging guidance to stay the wire for intraluminally approach is a good concept for the best vessel preparation of a target arterial path (TAP). To find the best TAP under the angiosome concept, the direct access of a chronic total occlusion orifice can perform under intravascular imaging guidance. The identification of lesion characteristic during vessel preparation, including plaque morphology, distribution of calcific lesion, depth and angle of dissection are a vital role to determine the proper device for EVT. Appropriately assessing of the vessel diameter under external elastic membrane base for sizing of leave nothing behind by balloon angioplasty or leave something behind by stenting are created the best long-term patency of TAP. The well apposition and expansion of scaffold under intravascular imaging can decrease the likelihood of in-stent restenosis (ISR) and other complications. A minimum stent areas that should be achieved at various locations during stenting are promising of the best stent patency. The neointimal hyperplasia and neoatherosclerosis are determine the proper special balloon or drug coating technology treatment for ISR.

Although the usage of IVUS and OCT are limited in clinical practice of chronic limb-threatening ischemia (CLTI), due to learning curve for image interpretation and unclear guidelines and cost-effectiveness for optimal EVT. There are a lot of studies supports intravascular imaging guidance to improve EVT results, especially in high-risk CLTI patients with complex lesions. Therefore, the appropriate use of intravascular imaging in clinical practice of CLTI should be encouraged for the best limb salvage strategy.