Efficacy of three-dimensional roadmapping by fusion of computed tomography angiography with volumetric data from an angiography machine in endovascular therapy for iliac chronic total occlusion: a case report

BACKGROUND: The 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 PRESENTATION: A 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. CONCLUSIONS: The 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.