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Technique for obtaining proximal intraluminal control when arteries are inaccessible or unclampable because of disease or calcification  Frank J. Veith,

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Presentation on theme: "Technique for obtaining proximal intraluminal control when arteries are inaccessible or unclampable because of disease or calcification  Frank J. Veith,"— Presentation transcript:

1 Technique for obtaining proximal intraluminal control when arteries are inaccessible or unclampable because of disease or calcification  Frank J. Veith, MD, Luis A. Sanchez, MD, Takao Ohki, MD  Journal of Vascular Surgery  Volume 27, Issue 3, Pages (March 1998) DOI: /S (98) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

2 Fig. 1 A, Diagram of patient with heavily scarred groin from previous surgery. To perform femorodistal bypass only the anterior surface of distal common femoral artery must be dissected. Site of guide wire and sheath insertion is indicated by asterisk. B, Guide wire has been inserted short distance through needle. Needle has been removed, and hemostatic sheath and its dilator are being advanced over guide wire. Entrance through arterial wall is facilitated by rotating sheath and dilator as they are advanced as unit. Journal of Vascular Surgery  , DOI: ( /S (98) ) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

3 Fig. 2 After removal of dilator, directional catheter (Berenstein) is inserted through sheath over wire. Then under fluoroscopic guidance wire is advanced well into external iliac artery. Journal of Vascular Surgery  , DOI: ( /S (98) ) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

4 Fig. 3 Catheter is removed, leaving wire and sheath in place. Dilator is replaced, and sheath and dilator are advanced over wire well into external iliac artery. Journal of Vascular Surgery  , DOI: ( /S (98) ) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

5 Fig. 4 Dilator is removed along with guide wire, leaving sheath within iliac artery. Balloon catheter is advanced within sheath. After appropriate positioning of balloon with fluoroscopic guidance and contrast injection as needed, sheath is partially withdrawn, and balloon is inflated to occlude external iliac artery and two of its branches (inset). Journal of Vascular Surgery  , DOI: ( /S (98) ) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

6 Fig. 5 After obtaining distal arterial control, sheath is removed and site of its entrance extended as arteriotomy for distal bypass. Balloon catheter remains in place and provides proximal control. It can be removed as last few stitches of proximal anastomosis are tightened (inset). If catheter-sheath introduction site is not extended as origin of bypass, it can be closed primarily with sutures. Journal of Vascular Surgery  , DOI: ( /S (98) ) Copyright © 1998 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

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