Practical use of duplex echo-guided recanalization of chronic total occlusion in the iliac artery

Although endovascular therapy for peripheral arterial disease has undergone tremendous changes, chronic total occlusion (CTO) remains a significant challenge for interventionalists. Failed CTO recanalization is predominately due to unsuccessful guidewire crossing. In particular, the unique characteristics of tortuous and deeply located large vessels in the retroperitoneal cavity create challenging endovascular procedures. Real-time guidance based on external direct vessel visualization might be a promising tool for successful recanalization of noncalcific CTO. Here, we describe the practical use of duplex echo-guidance during the procedural course of iliac CTO recanalization.