Transcutaneous ultrasound-guided endovascular crossing of infrainguinal chronic total occlusions

Currently available techniques for the endovascular treatment of infrainguinal arterial chronic total occlusions (CTOs) require long procedure duration, large contrast volumes, complex subintimal dissection technique, and have low-intermediate success rates. Inability to remain intraluminal and/or reenter the true lumen after subintimal dissection remains the main reasons for procedural failure. We report for the first time a novel, simple, and reproducible technique that can significantly improve both the success and safety of endovascular intraluminal crossing of totally occluded peripheral arterial segments: the transcutaneous ultrasound-guided (TUG)-CTO technique. We used transcutaneous ultrasound guidance to cross long segments of superficial femoral artery CTO using a blunt-microdissection technique.