Approaches and considerations for optimal vessel sizing in peripheral vascular interventions

Background

Vessel sizing has played a pivotal role in guiding balloon and stent selection for coronary interventions, thereby decreasing dissections, vessel stress, and rates of restenosis. Despite its proven benefits in the coronaries, its application in peripheral vascular interventions has remained relatively underexplored.

Methods

This review aims to identify invasive and noninvasive imaging modalities available for sizing peripheral vessels as well as elucidate how vessel sizing is affected by measurement techniques, observer variability, and vessel characteristics.

Results

Traditionally, digital subtraction angiography (DSA) has been the gold standard for guiding vascular interventions. However, emerging techniques such as intravascular ultrasound (IVUS) examination and optical coherence tomography offer alternative approaches to vessel sizing, including assessment of cross-sectional area and minimal effective diameter.

Results

IVUS examination has demonstrated larger vessel diameter measurements and less intraobserver and interobserver variability than DSA. Whereas direct comparisons between IVUS examination and optical coherence tomography in the peripheries has been limited, noninvasive modalities such as computed tomography angiography and magnetic resonance angiography (MRA) provide a three-dimensional approach on vessel sizing, yet their integration into procedural planning remains constrained. Initial studies suggest discrepancies between vessel sizing using CTA and magnetic resonance angiography, warranting further investigation. Moreover, vessel characteristics such as localization and degree of calcification have been shown to influence balloon and stent sizing, highlighting the need for tailored approaches in peripheral vascular intervention.

Conclusions

Overall, although disparities exist between DSA and invasive/noninvasive imaging modalities in peripheral vessel sizing, the long-term implications of these differences on procedural outcomes remain poorly understood. Preliminary evidence suggests an opportunity to enhance procedural success, mitigate restenosis rates, and enhance patient care through improved vessel sizing techniques.