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

BACKGROUND: The 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 so...

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Autores principales: Haraguchi, Takuya, Fujita, Tsutomu, Kashima, Yoshifumi, Tsujimoto, Masanaga, Watanabe, Tomohiko, Sugie, Takuro, Hachinohe, Daisuke, Kaneko, Umihiko, Kobayashi, Ken, Kanno, Daitaro, Sato, Katsuhiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8671592/
https://www.ncbi.nlm.nih.gov/pubmed/34905136
http://dx.doi.org/10.1186/s42155-021-00276-w
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author Haraguchi, Takuya
Fujita, Tsutomu
Kashima, Yoshifumi
Tsujimoto, Masanaga
Watanabe, Tomohiko
Sugie, Takuro
Hachinohe, Daisuke
Kaneko, Umihiko
Kobayashi, Ken
Kanno, Daitaro
Sato, Katsuhiko
author_facet Haraguchi, Takuya
Fujita, Tsutomu
Kashima, Yoshifumi
Tsujimoto, Masanaga
Watanabe, Tomohiko
Sugie, Takuro
Hachinohe, Daisuke
Kaneko, Umihiko
Kobayashi, Ken
Kanno, Daitaro
Sato, Katsuhiko
author_sort Haraguchi, Takuya
collection PubMed
description BACKGROUND: The 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 TEXT: The “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. CONCLUSIONS: The DIOL fashion is a useful and effective method to facilitate CTO treatment.
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spelling pubmed-86715922021-12-17 The “Direct tip injection in occlusive lesions (DIOL)” fashion Haraguchi, Takuya Fujita, Tsutomu Kashima, Yoshifumi Tsujimoto, Masanaga Watanabe, Tomohiko Sugie, Takuro Hachinohe, Daisuke Kaneko, Umihiko Kobayashi, Ken Kanno, Daitaro Sato, Katsuhiko CVIR Endovasc New Technologies BACKGROUND: The 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 TEXT: The “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. CONCLUSIONS: The DIOL fashion is a useful and effective method to facilitate CTO treatment. Springer International Publishing 2021-12-14 /pmc/articles/PMC8671592/ /pubmed/34905136 http://dx.doi.org/10.1186/s42155-021-00276-w Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle New Technologies
Haraguchi, Takuya
Fujita, Tsutomu
Kashima, Yoshifumi
Tsujimoto, Masanaga
Watanabe, Tomohiko
Sugie, Takuro
Hachinohe, Daisuke
Kaneko, Umihiko
Kobayashi, Ken
Kanno, Daitaro
Sato, Katsuhiko
The “Direct tip injection in occlusive lesions (DIOL)” fashion
title The “Direct tip injection in occlusive lesions (DIOL)” fashion
title_full The “Direct tip injection in occlusive lesions (DIOL)” fashion
title_fullStr The “Direct tip injection in occlusive lesions (DIOL)” fashion
title_full_unstemmed The “Direct tip injection in occlusive lesions (DIOL)” fashion
title_short The “Direct tip injection in occlusive lesions (DIOL)” fashion
title_sort “direct tip injection in occlusive lesions (diol)” fashion
topic New Technologies
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8671592/
https://www.ncbi.nlm.nih.gov/pubmed/34905136
http://dx.doi.org/10.1186/s42155-021-00276-w
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