Background: Intravascular ultrasound (IVUS) may be beneficial for guiding endovascular revascularization in patients with chronic limb-threatening ischemia (CLTI); however, its use remains limited.
Methods: We surveyed interventional radiologists, vascular surgeons, and interventional cardiologists in the United States, Canada, and the United Kingdom using a 13-question, anonymous online questionnaire to evaluate clinical equipoise, willingness to randomize, and opinions and perceptions regarding IVUS use in patients with CLTI undergoing endovascular revascularization.
Results: A total of 105 operators (5.7% response rate) participated in the survey: 42 interventional radiologists, 40 vascular surgeons and 23 interventional cardiologists. Operators indicated the main obstacles to adopting or expanding IVUS for endovascular revascularization were cost or lack of reimbursement (69.5%), concerns about longer procedural time (47.6%), and the absence of randomized data supporting its benefit (39.0%). Overall, 80.0% of operators agreed that a large, multicenter, randomized trial was required, and 77.1% were willing to randomize patients in such a trial.
Conclusion: In this multidisciplinary survey, the identified barriers for IVUS use in CLTI revascularization were cost/non-reimbursement, increased procedural time, and lack of randomized evidence. Given respondents' clinical equipoise and willingness to randomize, large randomized controlled trials are needed to inform clinical practice.
© 2026 The Author(s). Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.