Stent implantation for chronic total occlusion in the iliac artery using intravascular ultrasound-guided carbon dioxide angiography without iodinated contrast medium.

A 68-year-old male presented with claudication. His kidney function was impaired. Carbon dioxide angiography revealed the left external iliac artery was occluded. A retrograde approach was attempted from the left CFA. The wire was advanced into the subintimal and failed to re-enter the true lumen. An IVUS catheter was then introduced and positioned near the proximal site of the occlusion. A 0.018-in. wire was advanced with the antegrade approach under the guidance of IVUS image which is located in the false lumen. In this approach, true lumen wiring was achieved. Stenting was performed successfully without injecting any iodinated contrast medium.