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Long Sheath (long + sheath)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Use of a Long Preshaped Sheath to Facilitate Cannulation of the Coronary Sinus at Electrophysiologic Study

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2001
CHRIS B. PEPPER B.Sc.
CS Cannulation Using a Long Sheath. Introduction: Catheterization of the coronary sinus (CS) from the femoral vein can be challenging. We tested whether use of a long preshaped sheath facilitates CS cannulation. Methods and Results: One hundred four patients were randomized into two phases. In phase 1, consecutive patients were allocated to CS catheterization using the long sheath (n = 26) or standard 7-French 15-cm sheath (n = 25). If unsuccessful within 10 minutes, the alternative technique was used. Phase 2 assessed the utility of the long sheath in difficult cases. All patients initially were approached using the standard sheath. If cannulation failed after 10 minutes, patients were randomly allocated to the standard or long sheath approach. In phase 1, the standard approach failed in 4 (16%) of 25 cases. In each case, a long sheath proved successful (mean 3.2 min). The long sheath approach was successful within 10 minutes in all 26 cases. Catheter deployment was significantly quicker with the long sheath, but this was offset by the time required for sheath insertion. In phase 2, the standard approach was successful in 46 (87%) of 53 cases. Of 7 "failures," 3 were randomized to continue the standard approach, which was successful in 1; 4 were randomized to the long sheath approach, and success was achieved in all (mean 4.4 ± 1.5 min). Overall, the CS could not be promptly catheterized in 15% of cases within 10 minutes using the standard sheath, and no failures were seen using the long sheath. No complications arose from the use of either technique. Conclusion: The long sheath was uniformly successful in permitting catheterization of the CS from the femoral approach in both unselected and difficult cases. [source]

Pacemaker Lead Extraction with the Needle's Eye Snare for Countertraction via a Femoral Approach

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2002
DIDIER KLUG
KLUG, D., et al.: Pacemaker Lead Extraction with the Needle's Eye Snare for Countertraction via a Femoral Approach. Femoral approach pacemaker lead extraction is described as a safe and efficacious procedure. When the lead can not be removed from its myocardial insertion, the "Needle's eye snare" has become available, and it allows a femoral approach traction associated with a countertraction . Between May 1998 and May 2000, 222 lead extraction procedures were performed in 99 patients using the femoral approach. This article reports the results of the 70 lead extractions requiring the use of the Needle's eye snare for femoral approach countertraction in 39 patients with a total of 82 leads. The indications were infection, accufix leads and lead dysfunction in 56, 1 and 6 leads, respectively. The age of the leads was 113 ± 56 months. Sixty-one (87.2%) leads were successfully extracted, the extraction was incomplete in 3 (4.3%) cases and failed in 6 (8.5%) cases. The failures were due to leads totally excluded from the venous flow for four leads, the impossibility of advancing the 16 Fr long sheath through the right and left iliac veins for one lead and one traction induced a nontolerated ventricular arrhythmia. In these cases, an extraction by a simple upper traction had been attempted in another center several months before. The complications included two deaths and one transient ischemia of the right inferior limb. Despite the selection of a series of leads for which an extraction by a simple traction on the proximal end of the lead was impossible or unsuccessful, femoral countertraction seems to be a safe and efficacious procedure. The failure of this technique occurred in patients with damaged leads due to a previous extraction procedure performed in centers with limited experience in lead extraction. [source]

Passing sheaths and electrode catheters through inferior vena cava filters: Safer than we think?,

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 6 2009
Yousuf Kanjwal MD
Abstract Inferior vena cava (IVC) filters are being inserted with increasing frequency for the prevention of pulmonary embolus. Previous case reports have documented the passage of up to three electrode catheters or an individual long sheath through an IVC filter. The current report expands on prior series with regard to the number of devices used. We describe our experience in 10 patients in whom up to five electrode catheters and/or sheaths were placed through an IVC filter using a transfemoral approach under fluoroscopic guidance without routine venography. Devices were successfully introduced and withdrawn in each case without filter dislodgment. Our series illustrates the feasibility and safety of passing multiple electrode catheters and long sheaths through an IVC filter. Evidence is accumulating to suggest that an IVC filter should not be considered an absolute contraindication to performing diagnostic or therapeutic procedures. © 2009 Wiley-Liss, Inc. [source]

Carotid endarterectomy with simultaneous retrograde common carotid artery stenting: Technical Considerations,

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 7 2008
Hernan A. Bazan MD
Abstract Carotid endarterectomy with simultaneous retrograde common carotid artery stenting (CEA-RCCAS) is performed with increasing frequency to treat tandem common and internal carotid artery stenoses. Technical details are not clearly delineated in the literature. Our procedure aims to maximize procedural ease and cerebral protection. Although the need for the endovascular component being performed first, followed by shunt placement, and the use of short wires and sheaths has been advocated, we describe the avoidance of shunt placement and the use of long sheaths to facilitate the procedure using local anesthesia and cervical blockade. Use of local anesthesia, avoidance of a shunt, and use of a long sheath may increase the procedural applicability and safety in some patients. CEA-RCCAS permits safe simultaneous treatment of tandem common and internal carotid artery stenoses. The use of technical adjuncts described here will permit further expansion of the procedure to allow additional patients to be treated in this hybrid fashion. © 2008 Wiley-Liss, Inc. [source]

Extreme coronary guide catheter support: Report of two cases of a novel telescopic guide catheter system

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 6 2006
Adam T. Stys MD
Abstract Extra support of the guiding catheter is required in selected cases of percutaneous coronary intervention (PCI). We describe two successful cases of PCI of very calcified and tortuous right coronary arteries in which a novel telescopic guide system was devised. The system utilizes a long sheath that "armors" the guide catheter. The operator can adjust the support of the guiding system from soft up to extremely stiff. © 2006 Wiley-Liss, Inc. [source]

Endovascular stent implantation in the pulmonary arteries of infants and children without the use of a long vascular sheath

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2002
Robert H. Pass MD
Abstract Endovascular stent implantation for pulmonary artery stenosis requires the use of a long, large-bore vascular sheath to insure precise implantation without embolization or malposition. A long vascular sheath may be difficult to position and usage may be associated with vascular compromise and/or hemodynamic embarrassment, especially in infants and small children. We report a new technique for pulmonary artery endovascular stent implantation without the use of a long sheath. From December 2000 to May 2001, 10 patients underwent implantation of 13 Palmaz Corinthian premounted biliary transhepatic stents for pulmonary artery stenosis. Median age was 0.8 years (range, 0.5,18.5) and median weight was 11.8 kg (range, 4.6,65). Patient diagnoses were tetralogy of Fallot (five), double outlet right ventricle (three), branch peripheral pulmonary artery stenosis (two), single ventricle s/p cavopulmonary shunt (one), and truncus arteriosus (one). All Palmaz Corinthian stents were delivered uncovered on Cordis Opta LP balloon catheters via short sheaths (6,7 Fr); super-stiff guidewires were not always necessary. These stents, with a maximal expanded diameter of 12 mm, were placed for peripheral pulmonary artery stenosis as a definitive procedure or at the pulmonary artery bifurcation in patients who were expected to undergo future open heart surgery. The stents were initially implanted on 4, 6, or 8 mm balloon catheters and further expanded if needed. Stents were placed in the right pulmonary artery alone in three patients, left pulmonary artery alone in four patients, and side-by-side stents were implanted simultaneously in three patients. All thirteen stents were implanted successfully in the desired location without stent malposition or embolization. Mean angiographic diameter increased from 2.5 ± 1.5 to 5.7 ± 1.4 mm (P < 0.01) and peak systolic ejection gradients decreased from 44 ± 22 to 14 ± 11.6 mm Hg (P < 0.01). The uncovered delivery of the premounted Palmaz Corinthian stent allowed for precise and safe endovascular stent implantation without the hemodynamic and technical problems associated with long vascular sheath usage. This technique is useful for the palliation of proximal pulmonary artery stenosis and is effective definitive treatment for peripheral pulmonary artery stenosis in small infants and children. Cathet Cardiovasc Intervent 2002;55:505,509. © 2002 Wiley-Liss, Inc. [source]