Fig. 2

 A, B Control angiography shows total occlusion of both tibial arteries, and very poor inframalleolar arteries. C A 0.014-inch guidewire (GW) is advanced into the subintimal space (white arrow: GW tip) in the posterior tibial artery (PTA). D, F, H Intravascular ultrasound (IVUS)-guided parallel wiring (D: proximal-to-middle PTA; F: distal PTA; H: lateral plantar artery). Yellow arrow: 1st GW and IVUS catheter; blue arrow: IVUS transducer; black arrow: 2nd GW advanced into the intraplaque of the PTA. E, G IVUS findings of the chronic total occlusion (CTO) lesion in the PTA (E: proximal-to-middle PTA; G: distal PTA). Yellow arrow: IVUS wire; blue arrow: IVUS transducer; black arrow: 2nd GW in the intraplaque route. I IVUS findings in the distal part of the lateral plantar artery. The IVUS transducer is almost in the center of the vessel. J The 2nd GW (black arrow) is advanced into the distal true lumen of the digital artery. Blue arrow: IVUS transducer. K A 2.5 × 200-mm balloon is dilated in the lateral plantar artery to the distal PTA. L A 4.0 × 100-mm balloon is dilated in the proximal PTA. M, N Final angiography shows sufficient dilation, antegrade blood flow, and small branches