Fig. 3

a Preprocedural enhanced computed tomography. b, c Control angiography showed total occlusion from the proximal aspect of the superficial femoral artery to the popliteal artery. The distal true lumen of the popliteal artery was minute (white arrow). d AnteOwl WR intravascular ultrasound (AnteOwl IVUS) could be advanced to the popliteal artery (white arrow). e IVUS findings of a superficial femoral artery distal lesion. The IVUS catheter was in the subintimal space. The white arrow shows the IVUS wire. The IVUS wire and transducer coincided with right anterior oblique 20° (blue arrow), and left anterior oblique 16° was maximally separated of IVUS and target plaque (red arrow). The yellow arrow shows that the direction of the second guidewire should be advanced. f Cross-sectional image from the proximal position (operator position). The transducer was on the surface side and the target plaque was on the right side of the IVUS catheter. g We converted the intravascular ultrasound (IVUS) findings into an angiographic image. The IVUS wire was on the right side (left anterior oblique side), the transducer was in the center, and the second guidewire was on the left side (right anterior oblique side) on angiography; these findings are almost the same as the IVUS findings in e White arrow shows the tip of AnteOwl WR IVUS. h, i IVUS findings of the popliteal artery lesion. The blue arrow shows the IVUS wire. The yellow arrow shows the IVUS transducer. The red arrow shows the direction of the target plaque at which we aimed. The target plaque was on the left side of the IVUS catheter. j The IVUS wire was in the center, the transducer was on the left side, the second guidewire was on the right side (left anterior oblique side) on angiography; these findings are almost the same as the IVUS findings. k Positional relationship between patient and operator and direction of IVUS