Tampa Bay catheter: a new guiding catheter for endomyocardial biopsy via femoral approach.

Initially, endomyocardial biopsies were obtained almost exclusively using the jugular vein approach. Lately, the femoral vein route has gained popularity and in many centers, including ours, it is preferred. Despite this, guiding catheters specifically designed for endomyocardial biopsy via femoral vein approach are not available. Here, the experience with the Tampa Bay catheter, designed for endomyocardial biopsy using the femoral vein is described. From 1-1-89 to 1-31-90, a total of 486 endomyocardial biopsies were performed in 78 post-heart transplant patients (1-17, mean 6 per patient); 106 were performed via internal jugular vein (22%) and 380 (78%) via femoral vein. Of these, 100 were performed using the Tampa Bay catheter. The remaining 280 biopsies were done using a long sheath or a Judkin's right coronary angioplasty guiding catheter. Biopsy specimens were adequate for diagnosis of rejection in all 106 biopsies performed via internal jugular vein (100%) in 99 of 100 biopsies via femoral vein using the Tampa Bay catheter (99%) and in 274 of the 280 (98%) biopsies using the long sheath or the right Judkin's coronary angioplasty guiding catheter (NS). The femoral vein is larger and easier to find than the internal jugular vein. More important, complications such as right pneumothorax, Horner's syndrome, recurrent laryngeal nerve paralysis, and right phrenic nerve paralysis, known to occur when the internal jugular vein approach is used, can be completely avoided when the femoral vein approach is used.     

Alternative approaches to right ventricular endomyocardial biopsy

Cardiologists are performing endomyocardial biopsy procedures with increasing frequency, particularly in patients who have undergone cardiac transplantation. Because of the necessity for performing multiple biopsies in many of these patients and the subsequent complications that may arise, we have developed a simple and efficient technique for obtaining endomyocardial biopsy samples. As an alternative to retrieving biopsy samples by the conventional right internal jugular or femoral venous approach, we use the right or left internal jugular or subclavian approach. The procedure utilizes a 7 Fr 35 cm sheath and dilator system placed into the right ventricle over a balloon-tipped catheter. After the sheath is positioned via either the internal jugular or subclavian vein, multiple samples can be obtained with standard available bioptomes. The sheath may then be exchanged for a triple-lumen catheter if desired. This approach permits routine changing of the central venous access lines within the sterile confines of the catheterization laboratory, with minimal discomfort to patients. We believe that this method represents an important alternative to conventional biopsy techniques.     

Endomyocardial biopsy in heterotopic heart transplant recipients via the femoral vein

The results of endomyocardial biopsy (EMB) via the femoral vein in heterotopic heart transplant recipients were retrospectively analyzed and compared with those obtained using the right internal jugular vein approach. A total of 139 EMB were performed in 8 patients using the femoral (35) or the jugular (104) approach. Twenty three (64.7%) of the procedures performed via the femoral vein were part of the yearly hemodynamic and coronary artery study, and 12 (35.3%) constituted a routine postoperative evaluation of the myocardium rejection state in patients with imperviousness of the right internal jugular vein. Comparing the results obtained with the femoral approach, we observed a higher overall success rate (94.3 vs 88.5%, NS) and obtained more samples that were useful for histologic evaluation (95.5 vs 85.9%, NS); with the jugular procedure, the fragments were significatively larger in diameter (1.28 ± 0.55 vs 1.61 ± 0.85 mm, mean ± SD) and in area (1.49 ± 1.16 vs 2.28 ± 2.24 mm², mean ± SD). No cardiac or local complications were noted when the femoral approach was used, while two attempts to perform biopsy via the jugular vein resulted in obstruction of this vessel. Our data suggest that the femoral venous approach for endomyocardial biopsy in heterotopic heart transplant recipients is a valid alternative to the more commonly used routes.     

The femoral venous approach to endomyocardial biopsy: Comparison with internal jugular and transarterial approaches

Endomyocardial biopsy is often used in the clinical evaluation of cardiac disease. Among 134 consecutive procedures (280 myocardial samples), 3 approaches were compared: right internal jugular (n = 69), femoral arterial (n = 30) and femoral venous (n = 35). The femoral venous approach is a new method with which a preformed guiding sheath is used to allow sampling of the apical right ventricular portion of the ventricular septum. Vascular access and myocardial sampling were successful in all femoral venous and left ventricular (LV) procedures; however, the internal jugular vein could not be located to allow biopsy in 12% of neck approaches (p <0.025). One case of pneumothorax occurred after an internal jugular approach. Chest pain occurred after 10% (3 patients) of the LV, 4% (3 patients) of internal jugular and 3% (1 patient) of femoral venous procedures. Hypotension associated with biopsy was noted after 3 internal jugular and 2 LV procedures. Pericardial effusion was observed in 3 patients after an LV procedure (p <0.01). In 1 of these patients tamponade developed. The femoral venous approach had the highest overall efficiency (successful biopsy, lack of adverse events, p <0.05). This approach may become the procedure of choice for routine endomyocardial biopsy because it allows reliable vascular access and myocardial sampling with a low incidence of adverse reactions.     

Cardiac catheterization through the internal jugular vein in pediatric patients. An alternative to the usual femoral vein access.

The percutaneous femoral vein approach is used routinely for cardiac catheterization in the pediatric age but in some children, it may be impossible as in the case of iliac vein or inferior vena cava thrombosis due to previous cardiac catheterization, or inconvenient as for right ventricular endomyocardial biopsies. In the period between 1982 and 1990, 160 cardiac catheterizations or right ventricular endomyocardial biopsies were performed in 102 children. Patients ranged in age between 2 months and 17 years (mean, 3.8 years) and in weight from 3.2 to 57.3 kg (mean, 14.4 kg). Indications for the internal jugular vein approach were as follows: (1) thrombosis of the inferior vena cava due to previous cardiac catheterization in 42 patients (41 percent); (2) right ventricular endomyocardial biopsy after cardiac transplant in 19 patients (19 percent); (3) control catheterization of the pulmonary arteries following classic or bidirectional cavopulmonary anastomosis in 16 patients (16 percent); (4) superior vena cava obstruction following Mustard's procedure in 14 patients (14 percent); (5) failed percutaneous femoral venous approach in six patients (6 percent); and (6) absence of the hepatic segment of the inferior vena cava in four patients (4 percent). The right or left internal jugular vein could be entered in all but three procedures (98 percent). Seventeen patients had more than one procedure through the same internal jugular vein and the vein was found patent in all. A complete right heart cardiac catheterization was performed using this route. Right ventricular endomyocardial biopsy and interventional procedure were performed through this route. Two major complications occurred. A patient developed a central transient ischemic attack and another patient developed a persistent Horner syndrome. Accidental carotid puncture occurred in five patients without consequences. Our data indicate that cardiac catheterization in infants and children can be performed safely through the internal jugular vein, with a high success rate and a low incidence of major complications.     

A new method for right ventricular endomyocardial biopsy via femoral veins: a novel approach employing a right ventriculography catheter (Nishiya type)

We have devised a new method for right ventricular endomyocardial biopsy, in which the use of a right ventriculography catheter (Nishiya Type) allows us to ensure the introduction of a guiding sheath (Cordis, right-angled long sheath) to the apical portion of the right ventricle by way of the femoral vein. With this method, we have biopsied the endomyocardium in 52 patients during the last 4 years. In each case, it only took us several minutes to complete the biopsy procedure. Neither failed applications nor significant complications were seen. We believe that this technique provides a clinically beneficial means as it enables us to readily and safely achieve right ventricular endomyocardial biopsy.     

Percutaneous cardiac catheterization via the internal jugular vein in infants and children

Cardiac catheterization was performed via the internal jugular vein in 14 pediatric patients using a percutaneous sheath technique. Patients were 2 months to 16 years old and weighed 3.2-69 kg. We found that a low lateral approach for puncture of the vein was faster and more often successful than the high approach most often utilized in adult patients. No complications occurred in this series of patients. The internal jugular vein is a safe and reliable alternative to the femoral vein for cardiac catheterization if there is obstruction to the inferior vena cava or if it is desirable to leave an indwelling cardiac catheter.     

Closure of a coronary cameral fistula following endomyocardial biopsies in a cardiac transplant patient with a detachable balloon

Endomyocardial biopsy is the reference standard for the diagnosis of cardiac allograft rejection and is performed frequently in cardiac transplant patients. Biopsies are taken percutaneously via the right internal jugular or femoral vein [1,2]. Fistulas from coronary arteries into the right ventricle following endomyocardial biopsies are a relatively frequent finding (5–14%) [3–6]. Most of these fistulas are small angiographically, haemodynamically insignificant [5,6], and tend to disappear. We report a case of a haemodynamic significant coronary fistula, closed by a percutaneously introduced detachable balloon. © 1993 Wiiey-Liss, Inc.     

New guiding catheter configuration for aortocoronary vein graft angioplasty

A new family of four guiding catheters (8 French and 9 French) has been developed for angioplasty of aortocoronary vein grafts and native coronary arteries beyond vein graft insertions. In 67 consecutive grafts and native vessels dilated through the grafts in 54 patients, the procedural success rate was 97%. The G-1 standard catheter was employed for the majority of the procedures (66%), but the G-3 catheter was better for high anterior grafts and the G-4 catheter was better for high left grafts. The G-2 catheter was better for lower right grafts, especially in dilated aortas. Balloon angioplasty alone using 8 French catheters was performed in 60 procedures, and excimer laser with adjunctive balloon angioplasty using 9 French catheters was performed in 7 procedures. These unique guiding catheters provide an attractive alternative to existing vein graft guides by their improved seating and backup support. They may be the primary choice for vein graft angioplasty and may have future application in stent deployment and transluminal extraction catheter (TEC) atherectomy.     

Successful radiofrequency catheter ablation of a right posterolateral bypass tract in a patient with Wolff-Parkinson-White syndrome after a previous failed ablative procedure: taking the high road

A 16-year-old high school basketball player with symptomatic Wolff-Parkinson-White syndrome underwent an unsuccessful radiofrequency catheter ablative procedure from the femoral venous approach. During this procedure, the patient received 30 applications of radiofrequency energy without injury to the accessory pathway. The patient was treated with flecinide 100 mg orally twice daily and rescheduled for a second ablative procedure via the right internal jugular venous approach. At the second session, prior to any right internal jugular venous applications, 3 additional applications were delivered via the right femoral venous approach using a different catheter, without success. A single radiofrequency energy application from the right internal jugular venous approach eliminated the bypass tract in approximately 2 seconds. The superior approach achieved a more stable catheter position thereby eliminating the bypass tract. In conclusion, an alternative plan of attack should be considered after multiple failures from a given approach. In other words, take the high road if you can't take the low road.     

Coronary angioplasty using an over-the-wire balloon catheter through a new 6 French guiding catheter.

A new 6 French (F) guiding catheter with a large, teflon-coated internal lumen (4.2F) was developed, permitting use of the standard ultralow profile (less than 3F) over-the-wire system. This small coronary angioplasty system (6F-PTCA) was evaluated in 48 lesions in 45 of 137 patients (33%) who underwent coronary angioplasty between September 1990 and January 1991. The mean age was 64 years (range 49 to 82); 37 (82%) were male. The procedure was via the brachial artery in 28 patients (62%). The overall primary success rate was 96%. It was 100% via the brachial artery and 90% via the femoral artery. There were no major complications. The puncture compression time with the 6F-PTCA via the brachial artery and via the femoral and with 8F-PTCA via the femoral was 3.8, 9.6, and 16.9 hr, respectively (P less than 0.001), although the procedure time of the 6F-PTCA via brachial and via femoral and of the 8F-PTCA was not significantly different. The mean hospital stay was 3.1, 4.5, and 5.5 days, respectively (P less than 0.01). A small hematoma occurred in 2 patients (4.4%) after the 6F-PTCA and in 3 (3.3%) after 8F-PTCA, and a large hematoma (greater than 5 cm) was noted in 7 patients (7.6%) after 8F-PTCA. These results indicate that coronary angioplasty using the over-the-wire system through the new 6F guiding catheter is technically feasible. Moreover, this approach, especially when advanced via the brachial artery, could shorten the hemostasis time and facilitate early ambulation.     

Relative efficiency and risk of endomyocardial biopsy: comparisons in heart transplant and nontransplant patients

Right ventricular endomyocardial biopsy remains the gold standard for the diagnosis of acute rejection of the cardiac allograft. Among 704 consecutive procedures performed in 39 transplant recipients (2,842 myocardial samples), endomyocardial biopsy by either the right internal jugular (n = 661) or the femoral venous (n = 43) approach was compared with 243 consecutive procedures performed in nontransplant patients (n = 149 and n = 94, internal jugular and femoral approach, respectively). The internal jugular vein could not be located in only 0.61% (4/661) of heart transplant versus 5% (7/149) of nontransplant procedures (P less than 0.001). Vascular access plus sufficient myocardial sampling was obtained in all but 0.61% (4/661) internal jugular procedures performed in heart transplant patients and in all but 7% (11/149) of those performed in nontransplant patients (P less than 0.0001). (Vascular access was achieved in all femoral venous procedures performed in both transplant and nontransplant patients; sampling was successful after vascular access in all heart transplant recipients and all but two [2.1%] nontransplant procedures.) Cardiac complications occurred in nontransplant patients after one internal jugular procedure (cardiac perforation with tamponade) and after one femoral venous procedure (pericardial effusion). No cardiac complications occurred in transplant recipients, but 2 other complications were observed: One local abscess and one superior vena caval perforation with hemothorax associated with hypotension, both after an internal jugular approach. The overall efficiency (no safety problem; vascular access and adequate sample) was higher among transplant than nontransplant procedures (99% vs 93%, respectively, P less than 0.0001). These observations continue to support routine application of endomyocardial biopsy for monitoring rejection in cardiac transplant patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

The brachial artery method to transluminal internal mammary artery angioplasty

A new catheter technique to perform angioplasty of the right or left internal mammary artery coronary graft utilizing the brachial artery approach is described. Utilization of the ipsilateral brachial artery permitted cannulation of the internal mammary artery with preformed polyurethane Teflon-lined guide catheters. The coronary dilatation catheter was passed through the guiding catheter into the internal mammary artery. This technique permitted successful access into the ipsilateral mammary artery in eight patients, the left internal mammary artery graft in five and the right in three patients. The angioplasty procedure was successfully performed in seven of eight cases (spasm of the left internal mammary artery precluded successful dilatation catheter passage in one case). No brachial artery complications were encountered. In two cases, angioplasty was successfully performed in additional coronary vessels. Follow-up of 1-16 months (mean: 7.7 months) revealed no clinical evidence of restenosis. The ipsilateral brachial artery approach utilizing preshaped guiding catheters for visualization and introduction of dilatation catheters into the internal mammary artery graft is a safe and successful approach, and it is an acceptable alternative to the femoral technique.     

Endomyocardial biopsy in heart transplantation]

From October 1984 to June 1991, 1,549 endomyocardial biopsies (EMB) were performed on 122 patients submitted to a Cardiac Transplant procedure (CT) at the Hospital Puerta de Hierro in Madrid. All biopsies were performed with the long sheath technique and the King bioptome. A total of 8,707 specimens were obtained, of which 7,311 (83.97%) were considered adequate for pathological examination. We did not find significant differences between the internal jugular (83.21%) and the femoral vein (84.82%) approaches. About 20% of the samples were not adequate for pathological evaluation after the fifth procedure performed on the same patient. There has been no deaths in our group. One patient (0.06%) had right ventricular perforation with tamponade that required surgical treatment. Two patients (2.98%) presented coronary fistulae related to EMB. The percent of other minor complications was less than 0.5%. EMB is mandatory for the control of rejection in the first year after cardiac transplantation, and has shown to be a reliable and safe method in experienced hands.     

Radiofrequency catheter ablation of the slow pathway for atrioventricular nodal reentry in a patient with an obstructed inferior vena cava

A 51-year-old man with an obstructed inferior vena cava underwent successful slow pathway catheter ablation using a superior venous approach. Two central venous sheaths were introduced into the right internal jugular vein using different approaches (anterior and posterior), so the two sheaths located away from each other could prevent the catheters from 'sticking' to one another. The transseptal long sheath enabled a stable positioning of the ablation catheter. A nonfluoroscopic mapping system could reduce radiation exposure to the ablator. These techniques may be useful to overcome the disadvantages of the superior venous approach compared to the inferior venous approach.     

Transradial simultaneous kissing stenting (SKS) with SheathLess access

Transradial coronary intervention is usually performed via a 5 or 6 Fr sheath due to the small calibre of radial arteries. Simultaneous kissing stenting (SKS) technique requires a guiding catheter 7 Fr or larger and is therefore difficult to perform via transradial approach. Conversion to femoral approach or additional arterial access is usually required to achieve this goal. To overcome this limitation, a hydrophilic 7.5 Fr SheathLess guiding catheter can be exploited. This catheter possesses approximately the same size outer diameter as a 6 Fr sheath and an internal diameter of a 7.5 Fr catheter. A smooth and successful performance of SKS through transradial approach is described using this catheter. © 2009 Wiley‐Liss, Inc.     

Use of the left internal jugular vein approach in endomyocardial biopsy

Endomyocardial biopsy is conventionally performed by accessing the right internal jugular vein. The alternative approach is via the femoral veins. We describe the safe and effective use of the left internal jugular vein with a standard Caves-Schulz bioptome. © 1994 Wiley-Liss,Inc..     

经股静脉途径放置冠状静脉窦导管的初步应用

使用可屈性多极导管经股静脉径路（Ａ组）置入冠状静脉窦（ＣＳ），并与锁骨下静脉径路（Ｂ组）进行比较。发现经股静脉径路放置ＣＳ导管具有快速、安全、成功率高的优点。Ａ、Ｂ两组从穿刺血管到置入ＣＳ导管所需时间分别为１．５±０．５ｍｉｎ和２２．６±７．２ｍｉｎ（Ｐ＜０．００１）。经股静脉径路放置ＣＳ导管不仅能满足射频消融时标测的需要，而且可减少血管穿刺部位，降低并发症。     

Short-term central venous catheter complications in patients with sickle cell disease who undergo apheresis

Patients with sickle cell disease (SCD) are prone to develop thrombosis and infection due to their inflammatory and immune deficiency state. These patients require red cell exchange therapy for treatment or prevention of hemoglobin S associated complications. Owing to vascular access problems, adult patients need central venous catheterization (CVC) for exchange procedures. Procedure related complications have been reported for long-term CVCs in pediatric patients. However, short-term CVC complications in adult patients are not clear. This report represents the results of documented complications of short-term CVCs in patients with SCD who undergo apheresis. A total of 142 non-tunneled catheters with average median diameter of 9 F (range 8–16 F) were implanted for apheresis. The catheters were mainly inserted through the right internal jugular vein (66.2 %). Total days of catheter were 412. Results were reported as a complication rate and event according to 1,000 catheter days and compared to a control group including 37 healthy stem cell donors. In the patient group, 1 (1 %) hematoma and 1 (1 %) infection were observed for internal jugular vein catheterization (3.7 hemorrhages and 3.7 infections according to 1,000 catheter days), whereas four (8.9 %) cases of thrombosis and 1 (2.2 %) infection (27 and 6.9 according to 1,000 catheter days) developed in femoral vein. There was a significant difference in terms of thrombosis (P = 0.009). In the control group, only individual developed thrombosis in internal jugular vein. Short-term CVC inserted through to the internal jugular vein seems to be safer than femoral vein in patients with SCD.     

A new technique for right heart catheterization with a swan-ganz balloon catheter via femoral vein in the patient with dilated right heart chambers,utilizing a modified transseptal-type sheath

Right heart catheterization with a Swan-Ganz balloon catheter via femoral vein in the patient with dilated right atrium and ventricle is frequently difficult due to excessive catheter coiling in the dilated atrium. A new technique is described in this situation. By using a modified transseptal-type sheath positioned counterclockwise in right atrium as an introducing sheath, a balloon catheter can be easily advanced to the distal pulmonary artery by smooth counterclockwise direction and secure support from this sheath.