Comparison of procedural success between two radial sheaths : Comparison of the 6-Fr Glidesheath Slender to 6-Fr standard sheath.

BACKGROUND: The most common cause of procedural failure in cardiac catheterization using the transradial approach is radial artery spasm. The aim of this study was to compare the procedural success rate of the 6­Fr Glidesheath Slender with the 6­Fr standard sheath in transradial coronary angiography and intervention. METHODS: Patients who underwent percutaneous coronary angiography via the transradial approach through placement of a 6-Fr Glidesheath Slender or a 6-Fr standard sheath for primary radial access were prospectively enrolled in the study. RESULTS: The study included 200 cases: 76 patients undergoing percutaneous coronary angiography with the Glidesheath Slender and 124 patients with the standard sheath. Failed procedures were recorded for 19 patients (9.5%), defined as inability to complete the procedure via the primary access. There was no difference in the percentage of failed cases between the Glidesheath Slender and standard sheath groups (10.5% vs. 8.9%, OR = 1.21, p = 0.8). More cases of spasm were observed in the Glidesheath Slender group compared with the standard sheath group, which was not statistically significant (7.9% vs. 5.7%, OR = 1.43, p = 0.56). Smoking, hyperlipidemia, and age influenced the procedural outcome in the Glidesheath Slender group, while body mass index, sex, and smoking impacted the procedural outcome in the standard sheath group. CONCLUSION: There is no difference in procedural success rates, as defined by the ability to complete the procedure via primary radial access, between the 6­Fr Glidesheath Slender and the 6­Fr standard sheath. Our study suggests that the patient characteristics that elevate the risk of procedural failure for Glidesheath Slender may differ from those for the standard sheath.

"Raking-in Technique:" Removal Of Brachiocephalic Vein Thrombus Using AngioVac® Device Within A Stented Venous Segment.

INTRODUCTION: A case is reported of left brachiocephalic vein thrombus removal using the Angiovac device within a stented venous segment via a through-and-through access technique. REPORT: This novel technique involves obtaining through-and-through access from the left basilic vein to the right femoral vein, which then facilitates the advancement of the Angiovac device to successfully remove in a stepwise fashion the thrombus present within a stented region of the left brachiocephalic vein. DISCUSSION: The Angiovac device has been shown to be very useful and effective at removing large amounts of thrombus, tumor, and foreign bodies within arterial and venous systems successfully. This novel technique uses the through-and-through venous access approach to allow for this device to remain close to the targeted area of thrombus burden and prevent damage of the already existing stents in this region.

Role of laser atherectomy for the management of in-stent restenosis in the peripheral arteries.

The prevalence of PAD is expected to increase as the population ages and the treatment for chronic disease becomes more sophisticated. The safety, efficacy, and lower cost of endovascular treatment for peripheral vascular disease of the lower extremities when compared with surgical revascularization are well known. Despite the clinical improvements and advances in endovascular techniques over the past decade, in-stent restenosis of peripheral arteries remains a challenge for the endovascular specialist. The use of excimer laser atherectomy has been shown to be safe and effective for the revascularization of complex, critical de novo peripheral lesions and offers promise in the treatment and prevention of in-stent restenosis.