Optical coherence tomography in peripheral arterial disease: A systematic review.

Background: Optical coherence tomography (OCT) is a novel adjunct in the field of medicine. The objective of this systematic review was to evaluate the role of OCT in the field of contemporary endovascular surgery in terms of its utility in diagnostics and interventions in peripheral arterial disease (PAD).

Method: A systematic search of literature published from 1st January 2009 to 1st August 2019 was identified from PubMed, Ovid and Cochrane library database with reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The pre-defined selection inclusion criteria were clinical applications of OCT in vascular surgery in relation to diagnostics and interventions. Keywords used included OCT, PAD, endovascular procedures and atherectomy.

Results: From an initial search of 310 articles, 27 articles were included in this systematic review: 15 articles were related to diagnostics: peripheral arterial disease was the most studied condition (n = 8), other conditions included in-stent restenosis (n = 4), fibromuscular dysplasia (n = 2) and acute limb ischaemia (n = 1); 12 articles were related to intervention: an OCT-guided crossing catheter was the most used assisting device (n = 10), with an OCT-guided atherectomy device used in four of these studies.

Conclusion: Although there is currently no level 1 evidence to suggest routine use of OCT in the diagnosis and treatment of PAD, current literature suggests that the use of OCT is safe and effective. The OCT real-time vessel wall structural images clearly distinguish normal anatomy from plaque pathology, and are of great advantage both in the accurate diagnosis and treatment of target lesion, especially in reducing the amount of radiation in the endovascular procedure.