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34542 views
  • TAVI Me G. M-L
  • 93 Y.O
  • Symptomatic AS. NYHA IV
  • severe COPD and Asthma
  • June & Aug 11 : Cardiac failure
  • EUROSCORE = 25,1 %
  • STS = 13,7 %

TOOL BOX Trans Radial Approach
Prepared by B. FAURIE & J. AZZI


1 - Puncture
- Home made plexiglass arm board for wrist hyperextension
- Emla® cream 1H before procedure on both wrists
- Local anesthesia with 1ml of Xylocaine® 1%.
- Venous canula 20 G built in the introducer kit 
- Radial cocktail injected through the sheath: verapamil 3mg, Risordan® (Trinitrine) 2mg
- IV Heparin 70 UI/kg (100UI/kg if PCI)

2 - Introducers
- Cordis RadialSource™ introducer kit available in 6.5 - 10 – 20 cm in 4F, 5F and 6F with a short 20G venous canula and either 0.014" polymer coated guidewire or 0.018" spring guidewire
 
Terumo Radifocus® introducer kit available in 7 and 10 cm in 4F, 5F, 6F with venous canula and plastic 0.021" wire
 
- Merit Medical Prelude® available in 4F, 5F and 6F
 
- Terumo Extralong (25cm) hydrophilic Radifocus® introducer for coronary spasm expertise (Methergin® testing) or extreme radial tortuosity. No spasmolytic cocktail administered
 
- Increase introducer diameter (4 to 5F or 6 or 7F...): Terumo or Cordis femoral introducer on the 0.035" J wire in place or SheathLess guiding catheter
 

3 - Wires for catheters advancement
- Cordis Emerald™ .035” J spring wire 150cm 
 
- Boston Scientific .035” J spring wire 150cm
 
- Cordis .035" Aquatrack™, hydrophilic guidewire if failure of .035” spring wire
 
- Terumo.035” Angled Glidewire Advantage™ (180cm) if failure of .035” spring wire (Terumo Glidewire®: J Tip .035”, 180cm length, Product Code #HR35183M)
 
- .014“Abbott Vascular BMW®, Pilot® 50 in case of extreme radial tortuosity or loops
 
- No need for exchange wires (210 or 260cm) if you use the hydrophilic mandrin technique : strong serum flushing with a 10cc luerlock syringe over the .035’ wire leaning against  the aortic cusp
 
- Amplatz Extra stiff spring wire 150cm if subclavian or inominate tortuosity or calcifications for catheters exchange

4 - Catheters
A- Diagnostic :
 
- Coronary :
- Cordis® 4 & 5F Judkins right and left (JL 3.5; JR 4), if elderlies patients or small sized persons
- Cordis® 5F Barbeau for other patients. 1 cath for LCA, RCA and LV
- Cordis® 5F and 6F RBL 4 / RBL 5, 1 cath for LCA and RCA 
    
Terumo TIGER (4; 4.5; 5) for LV angiogram: 5F Angled pigtail
 
  For Bypass:
            - JR for SVG and LIMA
            - AL1 and Barbeau for SVG 
            - Cordis Modified Mammary cath for selective injection of RIMA and LIMA via Right Radial: IM Barbeau or IM Bartorelli Cozzi        
            - Cordis Multipurpose 5F for GE graft

-Peripheral angiogram:
           - Cordis Multipurpose 125cm for selective injections of mesenteric, renals, iliacs
           - Simmons for carotids and subclavian 
           - Cordis Markerband pigtail 125 cm (NEW!) for pre-TAVI aortic and ilio-femoral measurement
           - Cordis and Cook Medical Pigtail  125 cm  4F and 5 F    

B- Intervention :
-LCA :
- Cordis® Vista Brite Tip® 5 or 6F XB 3, 3.5, 4 – JFL  ST and LT
- Terumo Heartrail® II BL 3.5, 4 
- Medtronic Launcher® 5 or 6 F  EBU 3,  3.5 , 4
- Asahi Intecc SheathLess 6.5, 7.5 or 8.5F. PB4

-RCA:
- Cordis® Vista Brite Tip® 5 or 6F Barbeau – JFR or AL1 if more backup needed 
Terumo Heartrail® II 5 and 6 F Ikari Right   or AL1 
- Asahi Intecc SheathLess 6.5, 7.5 or 8.5F.  AL1 or 2
- Medtronic Launcher®  AR1, AR2, ALR1,2, AL1 and  AL2

- Peripheral :
a: Renal, Mesenteric : 
- Cordis® Vista Brite Tip® 6F LBT MP 125cm or Barbeau 125cm  
- Asahi Intecc SheathLess MP 100cm (small persons)

b: Iliac: Cordis® Vista Brite Tip® 6F LBT MP 125cm

c: Carotid: Cook shuttle® or Asahi Intecc SheathLess 7.5 or 8.5F MP 100cm

5 - Specific devices
Active intubation and mother and child systems
Terumo Heartrail® II 5 in 6 - 120cm 
- Vascular solutions Guideliner®  5-in-6, 6-in-7, 7-in-8
- Abbott Vascular Wiggle® .014” wire by for increasing deliverability of stents in tortuosity and calcifications

6 - Closing devices
- Home made rolled pile of gauze with elastic adhesive tape. Good for very thin wrist
Terumo TR Band™ Product Code: XX*RF06 (Regular; 24cm) 
Access Closure Bengal™ Radial compression band
Merit Medical Finale™ compression device 
Saint-Jude Radistop™ compression assist device
 
Cordis

 

Shooting date : 2011-09-02
Last update : 2021-06-09

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