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Haraguchi T, Fujita T, Kashima Y, et al. The "Direct tip injection in occlusive lesions (DIOL)" fashion. CVIR Endovasc. 2021;4(1):87doi: 10.1186/s42155-021-00276-w.
Haraguchi, T., Fujita, T., Kashima, Y., Tsujimoto, M., Watanabe, T., Sugie, T., Hachinohe, D., Kaneko, U., Kobayashi, K., Kanno, D., & Sato, K. (2021). The "Direct tip injection in occlusive lesions (DIOL)" fashion. CVIR endovascular, 4(1), 87. https://doi.org/10.1186/s42155-021-00276-w
Haraguchi, Takuya, et al. "The "Direct tip injection in occlusive lesions (DIOL)" fashion." CVIR endovascular vol. 4,1 (2021): 87. doi: https://doi.org/10.1186/s42155-021-00276-w
Haraguchi T, Fujita T, Kashima Y, Tsujimoto M, Watanabe T, Sugie T, Hachinohe D, Kaneko U, Kobayashi K, Kanno D, Sato K. The "Direct tip injection in occlusive lesions (DIOL)" fashion. CVIR Endovasc. 2021 Dec 14;4(1):87. doi: 10.1186/s42155-021-00276-w. PMID: 34905136; PMCID: PMC8671592.
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CVIR Endovasc. 2021 Dec 14;4(1):87. doi: 10.1186/s42155-021-00276-w.

The "Direct tip injection in occlusive lesions (DIOL)" fashion.

CVIR endovascular

Takuya Haraguchi, Tsutomu Fujita, Yoshifumi Kashima, Masanaga Tsujimoto, Tomohiko Watanabe, Takuro Sugie, Daisuke Hachinohe, Umihiko Kaneko, Ken Kobayashi, Daitaro Kanno, Katsuhiko Sato

Affiliations

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

PMID: 34905136 PMCID: PMC8671592 DOI: 10.1186/s42155-021-00276-w

Abstract

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.

© 2021. The Author(s).

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

References

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