open access

Vol 75, No 7 (2017)
Original articles - new methods
Published online: 2017-03-31
Get Citation

“Buddy wire” for facilitation of femoral venous access for cryoablation: a preliminary report

Aleksander Maciąg, Michał Farkowski, Jan Ciszewski, Mariusz Pytkowski, Hanna Szwed
DOI: 10.5603/KP.a2017.0069
·
Kardiol Pol 2017;75(7):641-644.

open access

Vol 75, No 7 (2017)
Original articles - new methods
Published online: 2017-03-31

Abstract

Background: Some electrophysiological techniques, such as balloon cryoablation, involve the use of steerable sheaths of large diameter (outer diameter 15 Fr or more). Their introduction to the femoral vein may be difficult, especially in patients who have had numerous venipunctures in this area.

Aim: The authors describe a modification of typical venous access with the use of a “buddy wire” technique, facilitating the insertion of the cryoablation sheaths to the femoral vein.

Methods: A case-control study. The study involved a retrospective analysis of 27 consecutive procedures of balloon cryoablation of pulmonary veins performed in 2015 by the first author, compared to 23 consecutive procedures of balloon cryoablation performed in 2014 without a “buddy wire” technique. The study and control groups did not vary significantly. There were 11 women in both groups. The average age of the patients was 55.9 years. The “buddy wire” technique was the only difference in procedure performance between the control and study groups. In the study group a short introducer was inserted through a puncture of the right femoral vein, and then two wires were introduced through it. One of them was secured, so that it could not move, while the other served as a typical trans-septal puncture monitored with the use of X-ray. The standard trans-septal sheet was replaced with a 15 Fr steerable sheath, inserted through the same puncture site next to the secured “buddy wire”. The short wire was then removed from the femoral vein. Typical balloon cryoablation of pulmonary veins was performed. After the end of the procedure, the puncture site was secured with a haemostatic suture for 12–18 h.

Results: Femoral access with a 15 Fr steerable sheath and cryoablation were safely performed in all patients in the study group and in 22 out of 23 in the control group (100% vs. 95.6%, p = NS). Pulmonary vein isolation in one patient was performed using another technique. No damage to steerable sheaths was observed. There were no vascular complications requiring extended hospitalisation, blood transfusion, or surgical interventions in either group. The “door-to-door” time of the procedures ranged from 2 h 32 min on average in the study group to 2 h 43 min on average in the control group (p = NS). There was significant reduction in fluoroscopy time: 7 min 15 s on average from 11 min 25 s (p = 0.0009).

Conclusions: The use of the “buddy wire” technique may lead to significant reduction in fluoroscopy time during cryoablation of pulmonary veins by facilitating the insertion of the steerable sheaths to the femoral vein.

Abstract

Background: Some electrophysiological techniques, such as balloon cryoablation, involve the use of steerable sheaths of large diameter (outer diameter 15 Fr or more). Their introduction to the femoral vein may be difficult, especially in patients who have had numerous venipunctures in this area.

Aim: The authors describe a modification of typical venous access with the use of a “buddy wire” technique, facilitating the insertion of the cryoablation sheaths to the femoral vein.

Methods: A case-control study. The study involved a retrospective analysis of 27 consecutive procedures of balloon cryoablation of pulmonary veins performed in 2015 by the first author, compared to 23 consecutive procedures of balloon cryoablation performed in 2014 without a “buddy wire” technique. The study and control groups did not vary significantly. There were 11 women in both groups. The average age of the patients was 55.9 years. The “buddy wire” technique was the only difference in procedure performance between the control and study groups. In the study group a short introducer was inserted through a puncture of the right femoral vein, and then two wires were introduced through it. One of them was secured, so that it could not move, while the other served as a typical trans-septal puncture monitored with the use of X-ray. The standard trans-septal sheet was replaced with a 15 Fr steerable sheath, inserted through the same puncture site next to the secured “buddy wire”. The short wire was then removed from the femoral vein. Typical balloon cryoablation of pulmonary veins was performed. After the end of the procedure, the puncture site was secured with a haemostatic suture for 12–18 h.

Results: Femoral access with a 15 Fr steerable sheath and cryoablation were safely performed in all patients in the study group and in 22 out of 23 in the control group (100% vs. 95.6%, p = NS). Pulmonary vein isolation in one patient was performed using another technique. No damage to steerable sheaths was observed. There were no vascular complications requiring extended hospitalisation, blood transfusion, or surgical interventions in either group. The “door-to-door” time of the procedures ranged from 2 h 32 min on average in the study group to 2 h 43 min on average in the control group (p = NS). There was significant reduction in fluoroscopy time: 7 min 15 s on average from 11 min 25 s (p = 0.0009).

Conclusions: The use of the “buddy wire” technique may lead to significant reduction in fluoroscopy time during cryoablation of pulmonary veins by facilitating the insertion of the steerable sheaths to the femoral vein.

Get Citation

Keywords

femoral venous access, “buddy wire”, “cutting wire”, steerable sheaths, cryoablation

About this article
Title

“Buddy wire” for facilitation of femoral venous access for cryoablation: a preliminary report

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 75, No 7 (2017)

Pages

641-644

Published online

2017-03-31

DOI

10.5603/KP.a2017.0069

Bibliographic record

Kardiol Pol 2017;75(7):641-644.

Keywords

femoral venous access
“buddy wire”
“cutting wire”
steerable sheaths
cryoablation

Authors

Aleksander Maciąg
Michał Farkowski
Jan Ciszewski
Mariusz Pytkowski
Hanna Szwed

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Sp. z o.o. VM Group Sp.k., ul. Świętokrzyska 73 , 80–180 Gdańsk, Poland

phone:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl