Intravascular Ultrasound in Vascular Disease and Treatment

In this special issue of Vascular Disease Management, we have brought together experts in intravascular ultrasound (IVUS) to discuss the role of IVUS in current vascular surgical techniques. IVUS is playing an increasingly important role in complex endovascular procedures. In addition to angiography, which provides a “lumenogram”, IVUS provides axial imaging for determining arterial pathology. This is critical in cases of aortic dissection, endoluminal therapy and plaque morphology determination. In the first paper, Dr. Tara Mastracci from the Cleveland Clinic, discusses the role of IVUS for thoracic aortic pathologies. Of note, Dr. Mastracci is a widely recognized expert in thoracic aneurysms and dissections. She has great expertise in endoluminal treatment of thoracic aneurysms, dissections and the burgeoning field of fenestrated and branched endografts. As she points out, IVUS plays a critical role in determining the relationship of the true and false lumen in dissections that directs treatment. Dr. Buckley was an early adopter of IVUS and has been a pioneer in this arena. He was one of the first to show that outcomes with stenting are improved with the use of IVUS. This is due to the fact that axial imaging from IVUS can insure that arterial wall-stent apposition has occurred throughout the area of endovascular treatment. The technical issues related to IVUS are beautifully displayed in the figures accompanying the article. One of the rising stars in the military, Dr. Zak Arthurs, reviews the use of IVUS in peripheral occlusive disease. Both Drs. Buckley and Arthurs highlight the emerging importance of plaque morphology as determined by IVUS-mediated virtual histology. The use of IVUS in peripheral endovascular therapy has not been completely delineated. Dr. Arthurs indicates that future studies will hopefully prove that routine use can lead to improved patency of endovascular therapies and be of benefit to our patients. I completely agree with the conclusions of these authors that treatment of vascular diseases is enhanced by the use of IVUS. It will play an increasing role in endovascular procedures that are performed by vascular specialists. I hope the readers enjoy this very special issue.

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From the Division of Vascular Surgery and Endovascular Therapy, University Hospitals Case Medical Center, Cleveland, Ohio. The author reports no conflicts of interest regarding the content herein. Address for correspondence: Vikram S. Kashyap, MD, FACS, Division of Vascular Surgery and Endovascular Therapy, University Hospitals Case Medical Center, 11100 Euclid Avenue, LKS 7060, Cleveland, OH 44106. E-mail: vikram.kashyap@UHHospitals.org