Osami Kawarada, MD, Yoshiaki Yokoi, MD, PhD, Kazushi Takemoto, MT

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Presentation transcript:

Practical use of duplex echo-guided recanalization of chronic total occlusion in the iliac artery Osami Kawarada, MD, Yoshiaki Yokoi, MD, PhD, Kazushi Takemoto, MT Journal of Vascular Surgery Volume 52, Issue 2, Pages 475-478 (August 2010) DOI: 10.1016/j.jvs.2010.03.025 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 A, Color duplex ultrasound imaging shows occlusion of a left external iliac artery. Note the absence of color Doppler (heterogeneous echoic lesion) at the left external iliac artery. CFA, Common femoral artery; CIA, common iliac artery; EIA, external iliac artery; IIA, internal iliac artery. B, Baseline angiography shows left external iliac occlusion and right external iliac stenosis. C, External echo shows that the guidewire is advancing into the central lumen of total occlusion in the left EIA. D, Guidewire advancement. A 1.5-mm J-tip 0.035-inch hydrophilic guidewire (thin arrow) supported by the combination of a 4F multipurpose catheter (thick arrow) and a 6F crossover guide catheter (medium arrow) is bluntly advanced using step-by-step approach with the J-loop configuration. E, Duplex image shows that the guidewire is located in the subintimal space. F, Echo-guided penetration into the true lumen is achieved by adjusting the direction of guidewire. G, Final angiography shows the excellent result after bilateral iliac artery stenting. Journal of Vascular Surgery 2010 52, 475-478DOI: (10.1016/j.jvs.2010.03.025) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 A, Baseline angiography shows long total occlusion from external iliac artery (EIA) to the femoropopliteal artery. Note the collaterals through the internal iliac connecting to deep femoral artery. B Top, External echo shows the occlusive common femoral artery (CFA) and superficial femoral artery (SFA) and the patent deep femoral artery (DFA). Bottom, Echo-guidance enabled the navigation of the guidewire to SFA, not the DFA. C, Final angiography shows the excellent result after nitinol stent implantation for the EIA and SFA lesions. Journal of Vascular Surgery 2010 52, 475-478DOI: (10.1016/j.jvs.2010.03.025) Copyright © 2010 Society for Vascular Surgery Terms and Conditions