Practical use of duplex echo-guided recanalization of chronic total occlusion in the iliac artery
Osami Kawarada1, Yoshiaki Yokoi, Kazushi Takemoto
1Department of Cardiovascular Medicine, Kishiwada Tokushukai Hospital, Kishiwada-city, Osaka, Japan. kawarada90@hotmail.com
Insights
Duplex echo-guidance offers a promising solution for challenging peripheral arterial disease chronic total occlusions (CTOs). This technique aids guidewire crossing in tortuous iliac vessels, improving endovascular therapy success rates.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Medical Ultrasound
Background:
- Peripheral arterial disease (PAD) management has advanced, yet chronic total occlusions (CTOs) remain a significant challenge.
- Successful recanalization of CTOs is often hindered by difficulties in guidewire crossing, particularly in complex anatomies.
- Tortuous and deep retroperitoneal vessels present unique difficulties for endovascular procedures.
Observation:
- Real-time guidance using external direct vessel visualization is a potential tool for noncalcific CTO recanalization.
- Duplex ultrasound provides real-time visualization of the vessel's external anatomy.
- This visualization can potentially guide guidewire manipulation during challenging CTO interventions.
Findings:
- The study describes the practical application of duplex echo-guidance during iliac CTO recanalization.
- This technique was utilized to navigate the complexities of tortuous, deep iliac arteries.
- Successful guidewire crossing and recanalization were achieved using this visualization method.
Implications:
- Duplex echo-guidance may enhance the success rates of endovascular therapy for challenging CTOs.
- This approach could offer a valuable adjunct for interventionalists facing difficult iliac CTOs.
- Further research may explore the broader application of duplex echo-guidance in other complex CTOs.
Abstract:
Although endovascular therapy for peripheral arterial disease has undergone tremendous changes, chronic total occlusion (CTO) remains a significant challenge for interventionalists. Failed CTO recanalization is predominately due to unsuccessful guidewire crossing. In particular, the unique characteristics of tortuous and deeply located large vessels in the retroperitoneal cavity create challenging endovascular procedures. Real-time guidance based on external direct vessel visualization might be a promising tool for successful recanalization of noncalcific CTO. Here, we describe the practical use of duplex echo-guidance during the procedural course of iliac CTO recanalization.
