Slippery coaxial catheter system

A slippery coaxial, 3-F catheter device was developed for selective angiography, embolization, and infusion of chemotherapeutic agents. The device comprises three parts: an 0.018-inch, plastic-coated guide wire; a 3-F coaxial catheter; and a 6.5-F guiding catheter. Both the guide wire and coaxial catheter are coated with hydrophilic polymer, which becomes slippery when immersed in water. Experience with four patients indicates the new coaxial catheter device is capable of traversing tortuous vessels smoothly and safely, and it permits infusion of chemotherapeutic agents and 1-mm gelatin particles.     

Pigtail catheters used for percutaneous fluid drainage: comparison of performance characteristics

PURPOSE: To compare the performance characteristics of various single-lumen all-purpose pigtail drainage catheters. MATERIALS AND METHODS: The following parameters were compared: flow rates between catheters of the same size, whether changing the fluid viscosity has any effect on catheter comparisons, the effect on flow of leaving an open three-way stopcock in the drainage pathway, the tendency of the catheters to kink, and catheter patency after kinking, as measured according to flow. All-purpose 8.0-, 8.3-, and 8.5-F (collectively referred to as 8-F); 10.0-, 10.2-, and 10.3-F (collectively referred to as 10-F); and 12.0-F pigtail drainage catheters from three manufacturers were evaluated. Data were compared by using two-tailed t tests after normal distributions were confirmed. P < .05 was considered to represent a significant difference. RESULTS: At comparison of the 8-F catheters, the C.R. Bard catheters demonstrated better flow rates than the Cook and Boston Scientific devices. Among the 10-F catheters, there were no significant differences in the flow rates of fluid with viscosity equivalent to that of water between the C.R. Bard and Boston Scientific catheters; however, both these catheter types demonstrated significantly (P < .05) better flow rates than the Cook devices. Among the 12-F catheters, the C.R. Bard catheters demonstrated significantly (P < .05) better flow rates than the other two catheter types. Changing the fluid viscosity caused no changes in comparison results. In all catheter groups, the presence of a stopcock significantly (P < .05) impaired flow. None of the evaluated catheters demonstrated a clear advantage in terms of patency or susceptibility to kinking. CONCLUSION: At comparison of the in vitro performances of catheters from different manufacturers, the C.R. Bard 8.0-F and Cook 10.2-F catheters had comparable flow rates, and flow rates through the C.R. Bard and Boston Scientific 10.0-F catheters were comparable to flow rates through the Cook and Boston Scientific 12.0-F catheters. Varying viscosity had no effect on comparisons of catheter flow rates; however, a stopcock between the vacuum source and the catheter was noted to impair flow rates in all brands and sizes of evaluated catheters.     

无鞘7F普通导引导管经桡动脉介入治疗冠状动脉病变临床效果

目的 比较经桡动脉无鞘7F普通导引导管和常规6F鞘导引导管治疗冠状动脉病变的有效性和安全性.方法 回顾性分析2014年1月至2015年6月连续接受经皮冠状动脉介入治疗(PCI)手术的160例冠状动脉病变患者临床资料.随机分为无鞘组(n=80)和有鞘组(n=80),比较两种方法的导引导管到位、桡动脉创口压迫时间、止血成功、桡动脉痉挛、桡动脉术后血管直径、远端肿胀消退时间、前臂疼痛或不适、前臂血肿、假性动脉瘤、桡动脉闭塞、皮肤缺血坏死等.结果 无鞘组、有鞘组术中发生桡动脉痉挛分别为9例、2例,前臂疼痛或不适分别为7例、1例,差异均有统计学意义(P＜0.05).两组导引导管到位、桡动脉创口压迫时间、前臂血肿、止血成功、桡动脉术后直径、桡动脉闭塞及皮肤缺血坏死间差异均无统计学意义(P＞0.05).结论 与常规6F鞘导引导管相比,桡动脉无鞘7F普通导引导管治疗冠状动脉病变安全有效.     

Hematoma formation after diagnostic angiography: effect of catheter size.

The authors studied the effect of catheter size on the development of hematomas after catheterization. Four hundred ninety-nine patients who underwent routine diagnostic angiography were randomized to receive either 5-F or 7-F catheters. Small hematomas were more frequent in the 7-F catheter group (P less than .05); however, there was no difference in the frequency of larger hematomas between groups. Compression time was slightly but significantly (P less than .001) longer in the 7-F group. When catheter size; duration of the procedure; and patient age, weight, blood pressure and coagulation status were considered as independent variables, patient weight was the most accurate predictor of hematoma formation. The authors conclude that catheter size does not affect the development of a clinically significant hematoma after diagnostic angiography and that other factors such as patient weight are more important in this regard.     

Microcatheter placement through a side hole created in a 5-F catheter into proximal subclavian arterial branches causing hemoptysis

Five patients with moderate to massive hemoptysis who had a bronchial artery of anomalous origin or a nonbronchial systemic artery originating from the proximal subclavian artery underwent microcatheter placement through a created side hole of a 5-F catheter. All patients had pulmonary tuberculosis and had undergone bronchial artery embolization for hemoptysis. The side holes were made in the lesser (n = 2) or greater curvature sides (n = 3) of 5-F nonbraided Headhunter catheters. A microcatheter was passed through the side hole of the 5-F catheter into the target artery for embolization. Polyvinyl alcohol particles were used as the embolic material. The technical success rate was 100%, and immediate control of hemoptysis was achieved in all patients without complication.     

Injection characteristics and downstream contrast material distribution of flush aortography catheters: in vitro study.

Performance of 11 commercially available 4- and 5-F aortic flush catheters was evaluated with respect to the extent of upstream injection, catheter motion, and downstream homogeneity of a 10-, 15-, and 20-mL/sec bolus of 76% meglumine sodium diatrizoate at room temperature. Tests were made in a pulsatile aortic flow model containing circulating fluid isoviscous to blood. The injection process was recorded on videotape. Homogeneity of the contrast material bolus was determined spectrophotometrically from samples collected from the center and each of the four quadrants of the vessel lumen. Upstream contrast material injection between 1.5 and 7 cm in length emerged from all catheters; it was lowest with one of the "tennis racket" designs from one and a new spiral end-loop design (Halo) from another manufacturer. All catheters, except the most rigid and largest-caliber catheter (5.8 F) showed considerable shaft motion at the higher injection rates. Downstream contrast material mixing homogeneity was always best at the highest injection rate but altogether was better for the Halo catheter than for any other catheter tested. It is concluded that all tested 4- and 5-F aortic flush catheters show some undesirable features, but certain design modifications improve performance and comparative testing is helpful to distinguish such features.     

Clinical utility of coaxial reservoir system for hepatic arterial infusion chemotherapy

PURPOSE: To test the feasibility and clinical utility of a reservoir with coaxial catheters (a 2.9-F microcatheter and a 5-F catheter) and a port (ie, coaxial reservoir) that was developed to perform repeated hepatic arterial infusion chemotherapy (HAIC) in patients with unresectable liver neoplasms. MATERIALS AND METHODS: The coaxial reservoir was implanted in 64 patients with unresectable liver neoplasms as a result of difficulty in implanting a conventional reservoir with a 5-F catheter. The 2.9-F microcatheter tip was inserted into the gastroduodenal artery (n = 22), pancreaticoduodenal arcade (n = 20), or peripheral hepatic artery (n = 22) through the 5-F catheter, and a side hole created in the leading end of the microcatheter was oriented toward the proper hepatic artery. Technical success was defined by implantation of the coaxial reservoir and initiation of HAIC. The study endpoint was interruption of HAIC or death. Technical success and early and delayed complications were recorded. RESULTS: The technical success rate was 100%. HAIC was repeated every 1-4 weeks during the mean follow-up period of 14.1 months. Arterial infusion chemotherapy was interrupted in 17 patients (27%) as a result of hepatic arterial occlusion (16%, n = 10), catheter dislocation (3%, n = 2), catheter occlusion (3%, n = 2), wound infection (3%, n = 2), or breakage of the port (2%, n = 1). Patency rates of the hepatic artery were 96%, 82%, and 50% at 6 months, 1 year, and 2 years after reservoir implantation, respectively. CONCLUSION: Implantation of the coaxial reservoir is feasible, safe, and useful in expanding the indication of HAIC to patients with unresectable liver neoplasms.     

Use of a catheter with a large side hole for selective catheterization of the inferior phrenic artery

The authors report the use of a catheter with a large side hole in the catheterization of the right inferior phrenic artery (IPA) arising from the proximal portion of the celiac trunk. A 5-F catheter with a side hole on either the top or the right side of the superior portion near the tip was used in five patients with hepatocellular carcinoma fed by the right IPA, which could not be selected by a conventional coaxial technique. In all patients, a 3-F microcatheter was successfully advanced into the right IPA through the side hole of this catheter introduced into the celiac artery or the common hepatic artery.     

A 5-F needle-sheath system for translumbar catheter angiography

A 5-F needle-sheath catheter delivery system allows translumbar introduction and interchange of 4-F-catheters with various lengths and shapes. The system was used in 236 patients. In 227 cases, a pigtail catheter was introduced for outflow studies of the lower extremities or visualization of the aortic arch. In 9 cases a selective catheter (sidewinder, headhunter, cobra) for angiography of a total of 19 vessels (carotid arteries, visceral arteries, renal arteries) was used. No major complications related to aortic puncture or catheter manipulation occured, no relevant retroperitoneal hematomas were observed. The 5-F needle-sheath system is a safe and simple alternative to the more precarious transbrachial technique. Offprint requests to: Edgar A. Rinast     

A new twist on the Waltman loop for uterine fibroid embolization

The usual ipsilateral approach for uterine artery embolization is to form a Waltman loop. Newer nonbraided 4-F catheters can be problematic because of their tendency to kink or unfold while the loop is being formed. Herein, a modification of the Cope suture technique is described by which a Waltman loop is formed with use of a 4-0 Tevdek suture that allows the catheter to be folded back on itself, drawing it into the ipsilateral iliac artery. If necessary, the catheter can be prevented from unlooping by twisting the catheter on itself to lock it in position. The technique allows for efficient catheterization of the ipsilateral uterine artery.     

Maximal flow rates possible during power injection through currently available PICCs: an in vitro study

PURPOSE: Currently available 4-F and 5-F peripherally inserted central catheters (PICCs) were investigated to evaluate their possible application for contrast medium injection using power injectors. The study was performed using an in vitro model to demonstrate the feasibility of using PICCs for contrast-enhanced diagnostic studies. MATERIALS AND METHODS: An evaluation of 24 catheter versions consisting of 4-F single-lumen and 5-F dual-lumen PICCs from 13 different manufacturers was conducted. Six of the catheter types were silicone and 18 catheter types were polyurethane. Ten catheters of each type were evaluated with five at full length and five trimmed to 40 cm. With use of a silicone-based simulated SVC model, the catheters were infused with 50 mL of intravenous contrast medium at each flow rate increment. Catheters were tested at increasing flow rates from 0.5 to 5 mL/sec in 0.5-mL/sec increments using a Percupump CT injector. Catheters that failed to rupture were then infused at 1-mL/sec increments at flow rates from 5 to 17 mL/sec using a MedRad Mark V power injector. Tolerated and bursting pressures were recorded as well as the location of the catheter rupture. RESULTS: Polyurethane catheters ruptured at flow rates between 4 and 15.4 mL/sec, with one catheter not rupturing at the maximal flow rate (17 mL/sec). Silicone catheters ruptured at flow rates between 0.5 to 3.5 mL/sec. Average rupture locations by type and length were at the extension leg/hub connection area on five of the PICCs, on the extension legs on 21 of the PICCs, on the catheter/hub connection on four PICCs, and on the proximal catheter on 16 of the PICCs. CONCLUSION: The low burst rates at which all silicone catheters ruptured suggest that those catheters are not able to withstand typical flow rates used for CT arteriography. Conversely, although there is a wide range of discrepancy in the polyurethane catheter burst pressures, many polyurethane catheters can tolerate relatively high flow rates without rupture. This suggests that they may be safely used for CT arteriography with appropriate precautions and protocols in place.     

Uterine arteries: bilateral catheterization with a single femoral approach and a single 5-F catheter--technical note

In 197 patients, uterine embolization with a single femoral approach and a single 5-F cobra catheter was successful in 362 of 394 (92%) uterine arteries. In six patients (12 arteries), distal embolization with a coaxial 3-F microcatheter was safer. In 10 patients with a life-threatening condition, embolization was performed at the anterior division of both internal iliac arteries. Bilateral selective embolization of the uterine arteries can be performed with a single catheter.     

Venous thrombosis related to peripherally inserted central catheters

PURPOSE: To determine factors that may lead to venous thrombosis in patients with peripherally inserted central catheters (PICC). MATERIALS AND METHODS: The medical records of 678 patients with 813 PICCs during 1997 were cross-referenced with all patients receiving venous duplex examinations (1,631) during the same time period. Multiple factors were examined in the patients with catheter-related thrombosis, including diagnosis, solution infused, catheter tip position, vein accessed, and catheter diameter. RESULTS: Nurses placed 269 PICCs with 12 venous thromboses, for a rate of 4.5%. Radiologists placed 544 PICCs with 20 venous thromboses, for a rate of 3.7%. There was no significant difference in these rates. The overall thrombosis rate was 3.9%. After multivariate analysis, only catheter diameter remained significant. There were no thromboses in catheters 3 F or smaller. The thrombosis rate was 1% for 4-F catheters, 6.6% for 5-F catheters, and 9.8% for 6-F catheters. CONCLUSIONS: Thrombosis rate associated with PICCs was low (3.9%). The smallest acceptable catheter diameter should be used to decrease the incidence of venous thrombosis.     

Hepatic arterial embolization in cases of extensive celiac arterial stenosis.

Transarterial hepatic embolization was attempted in 10 and succeeded in nine patients with hepatocellular carcinoma accompanied by extensive celiac arterial stenosis. All catheterization was done through the femoral artery. In six cases, the tip of the catheter (2.5-F ball-tip microcatheter in three cases, 4-F ball-tip supple catheter in three cases) was placed in the proper hepatic artery through the pancreaticoduodenal collaterals. In three cases, a ball-tip microcatheter was injected from the guiding catheter, which was placed in a pinhole of the celiac trunk. These techniques involving flow-guided ball-tip catheters are of great value for hepatic arterial catheterization in cases of extensive celiac arterial stenosis.     

New technique for CT during arterial portography performed with left brachial artery approach

A new technique of CT during arterial portography (CTAP) performed with a left brachial artery approach is presented. We used 4-F, 50-cm J-shaped sheath introducer with a straight dilator and angled 4-F catheter with side holes. Catheter insertion to the superior mesenteric artery (SMA) can be performed without any trouble by the help of a J-shaped long sheath introducer positioned in the aortic arch. In our experience, 10 min compression of the puncture site and 2 h observation after catheter removal brought no local complication. This method can be performed safely on outpatient basis. Correspondence to: K. Itoh     

New high-flow "cloud" catheter for safer delivery of contrast material

The authors describe a new angiographic catheter, which delivers equal flow rates through the side holes and reduced flow through the end hole compared with conventional catheters. Computer analysis of catheter-flow models revealed that placement of larger side holes proximally and smaller side holes distally produces more uniform flow rates out of the holes. This decreases the risk of potentially hazardous delivery of high-pressure jets of contrast material from the end hole. The flow pattern is so uniform that it resembles a cloud of contrast material on injection. This catheter design is particularly applicable for 3-5-F catheters, which require high-pressure injections. Clinical testing in 50 cases revealed no extravasations or unintentional selective injections with use of this catheter.     

Outcome of polyester cuff retention following traction removal of tunneled central venous catheters

PURPOSE: To elucidate the factors that contribute to cuff retention during traction removal of tunneled catheters, as well as to determine the risk of complication associated with polyester cuff retention. MATERIALS AND METHODS: A total of 428 tunneled, cuffed catheters were removed with traction and local anesthesia. Polyester cuff retention was recorded when it occurred, and the effects of cuff retention were determined at a mean follow-up of 250 days. Statistical analysis was performed to determine the variables influencing cuff retention. RESULTS: Traction removal was successful in 428 (100%) patients. Of 428 catheters removed, 41 (10%) cuffs were retained. Silicone 10-F double-lumen and 9.6-F single-lumen catheters had a higher rate of cuff retention (27 [32%] of 84 and nine [39%] of 23, respectively) than did the split-tip polyurethane hemodialysis catheter (two [1%] of 196; P <.001). Cuff retention rates among other catheter types compared with that of the polyurethane catheter were not significantly different. Duration of catheter dwell did not significantly influence cuff retention. Of 41 retained cuffs, three required removal with cutdown for cuff migration to the exit site, which inhibited healing (n = 1); for suspected infection (n = 1); or for cosmetic purposes as requested by the patient (n = 1). The remaining patients had no complications associated with cuff retention. CONCLUSION: Traction removal of smaller-bore silicone catheters is more likely to result in cuff retention than removal of larger silicone and polyurethane catheters, and cuff retention is usually inconsequential.     

Brachiocephalic vessel: selective and superselective catheterization

The development of a catheter for easy and reproducible selective and superselective catheterization of the distal branches of the brachiocephalic arteries is reported. The catheter consists of a proximal 6- or 7-F braided wire shaft and a distal, nonbraided 10 cm made of thin-walled polyurethane with a 4- or 5-F diameter. The most distal 1 cm has a 105-degree curve and is not tapered at the tip. In this series, 209 patients were embolized in 277 separate procedures. Catheterization of the desired vessel was achieved in more than 95% of cases.     

Translumbar catheter angiography with a needle-sheath system

Translumbar catheter angiography with a new needle-sheath system was used in 175 patients and proved to be a safe and simple technique. No complications related to aortic puncture or catheter manipulation were observed. The 5-F sheath allowed the introduction of 4-F catheters of different lengths and shapes. Results of computed tomography performed after the procedures in ten patients, and intraoperative findings obtained in 22 patients, showed only minimal hematomas in the retroperitoneal space.     

Hysterosalpingography and fallopian tube cannulation: use of a double-balloon introducing catheter

A double-balloon introducing catheter for cervical cannulation is described. The catheter can be used for hysterosalpingography and allows coaxial passage of a 5-F curved catheter to selectively catheterize the fallopian tubes. The device has been used successfully in eight patients and may offer several advantages over other currently available equipment.