Angiology: Open Access
Open Access

Abstract

Extra and Intravascular Ultrasound (E&IVUS) Guided Wiring for Femoropopliteal Arterial Occlusive Lesions

Takuya Haraguchi*, Nozomi Sawada, Masanaga Tsujimoto, Yoshifumi Kashima, Katsuhiko Sato and Tsutomu Fujita

Background: Intravascular Ultrasound (IVUS) demonstrates the positions of intervention devices and vascular structures on a cross-sectional short axis to support interventional procedures, especially for complex morphological lesions. Extravascular Ultrasound (EVUS) visualizes vessel structures and devices on the long and short axes. EVUS　guided wiring reduces radiation exposure by avoiding fluoroscopy use. EVUS handling, which guides the direction in which the guidewire should go on both the long and short axes, is more complicated, stressful, and timeconsuming than IVUS. To solve this issue, we propose a new guidewire crossing method; extra and intravascular ultrasound (E&IVUS)　guided wiring, which uses both simultaneously.

Materials and methods: This is the first report on E&IVUS guided wiring for femoropopliteal arterial occlusions. EVUS guided wiring requires alternating long and short axis images to locate the devices. However, when EVUS is handled to change from a short axis to a long axis image, the long axis image may differ from the original long axis image. E&IVUS dedicate EVUS and IVUS to acquiring the long axis and the short axis view, respectively. As a result, E&IVUS reduce the stress due to the manipulation of the echo probe to switch from the long to short axis image and vice versa and may shorten the guidewire crossing time. Furthermore, intimal wire tracking can be performed according to the EVUS long axis and IVUS short axis images. The case involved a 76-year-old female with right superficial femoral artery occlusion. A hard guidewire supported with an over-the-wire type of IVUS was successfully passed into the plaque of the occluded lesion while confirming their positions with E&IVUS. An appropriately sized drug-coated balloon dilated the lesions according to IVUS measurements. Finally, adequate blood flow was obtained without complications.

Conclusion: E&IVUS guided wiring is a more rational lesion-crossing strategy than EVUS or IVUS alone. The clinical outcomes with this technique need to be evaluated.

Published Date: 2022-10-21; Received Date: 2022-09-20