c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Image-Guided Thrombectomy in Vascular Surgery: 28

A D V E R T I S E M E N T

   
 

Some of the advantages of image-guided over-the-wire thrombectomy are listed below:

• A larger catheter and balloon can be safely used when inflation is guided by visualization, avoiding the use of multiple catheters and balloons. 

• Variable inflation avoids endovascular trauma and dissection.

• Balloon deformation is a “local arteriogram”, pinpointing diseased areas for detailed imaging or direct treatment. 

• Wire passage prior to catheter deployment is a strong indicator of embolic or thrombo-stenotic etiology. The ability to pass a wire is strong predictor of outcome. A variety of techniques can be employed to traverse lesions inaccessible to a catheter alone.

• Distal positioning of the balloon is made possible by wire and image guidance. This prevents multiple passes with an inflated balloon and increases the likelihood of complete treatment with a single balloon pass. 

• The infusion of local contrast or therapeutic agents is accomplished by gentle inflation of the balloon and delivery of the agent through the wire lumen. This allows for lower volume but more concentrated contrast or therapeutic agent (e.g. thrombolytic agents, nitroglycerin, etc.).

• The access site can be chosen with more freedom since the proximity to branch points is not as crucial to catheter passage using selective over-the-wire catheterization techniques. For example, there is no need to expose the distal popliteal to approach tibial vessels. 

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Image-Guided Thrombectomy in Vascular Surgery: 29

A D V E R T I S E M E N T

   
 

Intraluminal Vascular Control and Site Specific Angiography

The Fogarty TLW Catheter can also be used as an endoluminal clamp. This is particularly useful when approaching difficult lesions. Distal control or other convenient arterial access can be obtained first, and a Fogarty TLW Catheter positioned at the desired site of proximal control. A sufficient amount of balloon inflation can be determined under fluoroscopy and the syringe limited to that volume. When occlusion is required, the balloon is simply inflated and the gate valve applied to fix the inflation at that level. A wire can be left in place in cases where risk of dislodgement is significant, allowing quick repositioning of the balloon in that event. This technique is particularly useful when approaching re-operative femoral lesions, infected or degenerative lesions, or any other lesion that would require difficult proximal or distal control. Calcified arteries or those those that are difficult or dangerous to clamp for any reason are also good candidates for intraluminal control. The catheter can simultaneously be used to infuse heparinized saline when used for control, avoiding the necessity of systemic heparinization in some cases.

Another potential use for the TLW is for site-specific arteriography. In this use, the balloon is inflated near the area of interest. A lesser volume of contrast can then be used to get a better arteriogram than using a bolus of contrast from a more distant location. Examples of this would include tibio-popliteal angiograms with the balloon inflated proximally, or inflow visualization of an ax-fem graft with the balloon inflated just distal to the anastamosis.

Vascular Surgeon: David H. Deaton

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This page was last modified on 4/3/2002.