Fig. 3

 A, B Preprocedural enhanced computed tomography. C, D, E Control angiography shows total occlusion from the right superficial femoral artery (SFA) to below-the-knee arteries. Distal target vessels are very faint. F IVUS findings of the CTO lesion in the SFA. Yellow arrow: IVUS wire; blue arrow: IVUS transducer; white arrow: 2nd GW in the intraplaque route. G Intravascular ultrasound (IVUS)-guided parallel wiring (G: SFA). Yellow arrow: 1st guidewire (GW) and IVUS catheter; blue arrow: IVUS transducer; white arrow: 2nd GW advanced into the intraplaque of the chronic total occlusion (CTO) lesion. H, J, L IVUS-guided parallel wiring (H: distal popliteal artery to peroneal artery; J: peroneal artery; L: distal peroneal artery). Yellow arrow: 1st GW; blue arrow: IVUS transducer; red arrow: 2nd GW advanced into the intraplaque of the CTO lesion. I, K IVUS findings of the CTO lesion in the below-the-knee artery (I: distal popliteal artery to peroneal artery; K: peroneal artery). Yellow arrow: IVUS wire; blue arrow: IVUS transducer; red arrow: 2nd GW in the intraplaque. M Tip injection from the distal peroneal artery shows the distal true lumen of below-the-ankle arteries. N, O, P, Q, R Final angiography shows sufficient antegrade blood flow