The “Direct tip injection in occlusive lesions (DIOL)” fashion

CVIR Endovascular

Ken Kobayashi¹  Katsuhiko Sato¹  Masanaga Tsujimoto¹  Daitaro Kanno¹  Tsutomu Fujita¹  Daisuke Hachinohe¹  Umihiko Kaneko¹  Tomohiko Watanabe¹  Takuya Haraguchi¹  Takuro Sugie¹  Yoshifumi Kashima¹ 

[1] Director of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, 007-0849, Sapporo, Hokkaido, Japan;

关键词: Chronic total occlusions;    Calcification;    Endovascular intervention;    Peripheral arterial disease;    Femoropopliteal artery disease;    Below-the-knee artery disease;    Critical limb-threatening ischemia;    Intermittent claudication;   

DOI  :  10.1186/s42155-021-00276-w

来源: Springer

【 摘 要 】

BackgroundThe successful intervention for peripheral artery disease is limited by complex chronic total occlusions (CTOs). During CTO wiring, without the use of intravascular or extravascular ultrasound, the guidewire position is unclear, except for calcified lesions showing the vessel path. To solve this problem, we propose a novel guidewire crossing with plaque modification method for complex occlusive lesions, named the “Direct tip Injection in Occlusive Lesions (DIOL)” fashion.Main textThe “DIOL” fashion utilizes the hydraulic pressure of tip injection with a general contrast media through a microcatheter or an over-the-wire balloon catheter within CTOs. The purposes of this technique are 1) to visualize the “vessel road” of the occlusion from expanding a microchannel, subintimal, intramedial, and periadventitial space with contrast agent and 2) to modify plaques within CTO to advance CTO devices safely and easily. This technique creates dissections by hydraulic pressure. Antegrade-DIOL may create dissections which extend to and compress a distal lumen, especially in below-the-knee arteries. A gentle tip injection with smaller contrast volume (1–2 ml) should be used to confirm the tip position which is inside or outside of a vessel. On the other hand, retrograde-DIOL is used with a forceful tip injection of moderate contrast volume up to 5-ml to visualize vessel tracks and to modify the plaques to facilitate the crossing of CTO devices. Case-1 involved a severe claudicant due to right superficial femoral artery occlusion. After the conventional bidirectional subintimal procedure failed, we performed two times of retrograde-DIOL fashion, and the bidirectional subintimal planes were successfully connected. After two stents implantation, a sufficient flow was achieved without complications and restenosis for two years. Case-2 involved multiple wounds in the heel due to ischemia caused by posterior tibial arterial occlusion. After the conventional bidirectional approach failed, retrograde-DIOL was performed and retrograde guidewire successfully crossed the CTO, and direct blood flow to the wounds was obtained after balloon angioplasty. The wounds heeled four months after the procedure without reintervention.ConclusionsThe DIOL fashion is a useful and effective method to facilitate CTO treatment.

【 授权许可】

CC BY