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CVIR Endovascular
Fig. 2 | CVIR Endovascular

Fig. 2

From: Clinical feasibility of endovascular recanalization with intravascular ultrasound-guided wiring for chronic total occlusion of below-the-knee arteries

Fig. 2

Successful revascularization with intravascular ultrasound (IVUS)-guided parallel wiring for complex below-the-knee (BTK) chronic total occlusion (CTO). A, B Control angiography shows total occlusion of both tibial arteries and very poor inframalleolar arteries. The target vessel was the right anterior tibial artery (ATA) to dorsalis pedis artery (DPA). C, D IVUS was placed on the first guidewire (GW) and the second GW and micro-catheter (MC) were advanced into the intraplaque of the ATA to DPA CTO lesion. Repeated IVUS-guided parallel wiring was performed to advance the true lumen of the DPA from the ATA. Red arrow: first GW with IVUS. Black arrow: second GW with MC. E IVUS findings of the CTO lesion in the DPA. White arrow: the second GW is in the true lumen. Black arrow: true lumen. Red arrow: IVUS on the guidewire. Yellow arrow: IVUS transducer. F The second GW was advanced into the distal true lumen. G IVUS measurement of the optimal size balloon dilation was performed. H, I Final angiography shows sufficient dilation, good antegrade blood flow, and small branches

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