Abstract

BackgroundThe usefulness of endovascular therapy (EVT) for the iliac artery has been established. However, difficult cases such as a long total occlusion and tortuous vessels are sometimes encountered. We recently performed rotational angiography with an angiography machine immediately before EVT and fused three-dimensional (3D) anatomical information obtained from preoperative enhanced computed tomography (CT) that had been performed in advance to create a 3D roadmap. We termed this method the CT fusion 3D roadmap (CTf3D-RM) technique and used it for treatment of iliac occlusive disease.Case presentationA 73-year-old man presented with pain in his left leg while resting. CT showed total occlusion from the ostium of the common iliac artery (CIA) to the distal part of the external iliac artery (EIA). A guiding sheath was inserted from the left common femoral artery using the CTf3D-RM technique, and the occlusive vessel was clearly observed. The guidewire could be passed retrogradely without bidirectional wiring. The time taken to pass the guidewire was only about 9 min despite the long and hard chronic total occlusion (CTO). Intravascular ultrasound showed that all of the guidewire followed the intraplaque route. After ballooning the entire lesion, we deployed two stent grafts and three bare nitinol stents from the left CIA ostium to the distal EIA. Final angiography showed good expansion and sufficient flow to the left leg.ConclusionsThe use of a 3D roadmap by fusion of CT angiography with volumetric data from an angiography machine in EVT for iliac CTO was shown to be effective.

Highlights

  • The usefulness of endovascular therapy (EVT) for the iliac artery has been established

  • Treatment of chronic total occlusion (CTO) is difficult because the occlusive vessel cannot be seen by angiography

  • Several imaging-guided wiring techniques such as intravascular ultrasound (IVUS) have been reported; each method has weaknesses associated with technical difficulty and the inherent limitations of the devices (Kawasaki et al 2008)

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Summary

Background

The usefulness of endovascular therapy (EVT) for the iliac artery has been established, and high treatment success rates and low complication rates have been achieved (Yamauchi et al 2019). We recently performed rotational angiography with an angiography machine immediately before EVT and fused three-dimensional (3D) anatomical information obtained from preprocedural enhanced computed tomography (CT) that had been performed in advance to create a 3D roadmap including virtual occlusive vessels. We named this method the CT fusion 3D roadmap (CTf3D-RM) technique. His pain during rest and cyanosis were dramatically improved after the procedure

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