EVAR was performed in a standard fashion. 6, 7 In brief, both common femoral arteries were surgically exposed. After hydrophilic guidewire (Terumo Medical Corporation, Somerset, NJ, USA) introduction into the iliac axis, major anatomical landmarks were carefully explored under fluoroscopic control to correctly select the stent-graft. An Amplatz super stiff guidewire (Boston Scientific, Marlborough, MA, USA) was placed to support stent-graft implantation. Stentgraft modeling with a compliant balloon (Cook Medical, Bloomington, IN, USA) was performed to set the device at the proximal neck and at the distal landing zone. Until December 2003, these procedures were performed in the operating room, allowing the use of IVUS for real-time road mapping of the abdominal aorta and major limbs before stent-graft implantation, as well as for postprocedure control. From January 2004, all procedures were carried out in an angiographic suite without IVUS. The procedure duration ranged between 88 and 156 minutes for the telementored group and between 75 and 170 minutes for the unmentored group. The contrast amount was 0 mL per patient in the telementored group (due to the use of real-time IVUS control) and 80 to 240 mL per patient in the unmentored group.
Hydrophilic guidewire
Manufactured by Terumo
Sourced in Japan
The Hydrophilic guidewire is a medical device designed for use in various medical procedures. It features a hydrophilic coating that reduces friction and enhances lubricity, facilitating smooth navigation through the body's vascular system.
Automatically generated - may contain errors
5 protocols using hydrophilic guidewire
1
Endovascular Aneurysm Repair Protocol
2
Transradial Coronary Procedure Protocol
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In this procedure, 1 mL of 1% lidocaine was subcutaneously injected for local anesthesia, then the right or left RA was punctured using a 20-gauge needle and a 0.635 mm (0.025 inch) hydrophilic guidewire (TERUMO Co., Tokyo, Japan) was inserted through the needle. The sheath size used was 6F–7F (external diameter 2.48–2.68 mm). With the sheath in place, 0.2 mg of nitroglycerin and heparin (5000 IU for percutaneous coronary angiography or 10000 IU for percutaneous coronary intervention) were introduced. After completing the transradial coronary procedure, the arterial sheath was removed and hemostasis was achieved by RA hemostasis device placement over the artery, each of which was applied as a one-time 4 h decompression, followed by bandage compression of the punctured site.
3
Transjugular Intrahepatic Portosystemic Shunt Creation
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TIPS creation was performed by experienced interventional radiologists. Catheterization of the hepatic vein was implemented through the right internal jugular vein with a transjugular liver access set (RUPS-100; Cook Inc.). Then a TIPS needle was used to puncture the portal vein under fluoroscopic guidance. After successful puncture of the portal vein with a TIPS needle, a hydrophilic guidewire (Terumo, Tokyo, Japan) was sequentially introduced into the main portal vein, superior mesenteric vein or splenic vein. After the intrahepatic tract was dilated with a balloon catheter, an 8 mm ePTFE-covered stent (Fluency; Bard Corporation or Viabahn; Gore Corporation) was placed in the intrahepatic duct. Measurement of portal pressure gradient (PPG) was performed before and after shunt establishment. The target value of PPG was below 12 mmHg or, alternatively, a reduction of at least 20% from the baseline13 (link). For varicose vein embolization, coil and tissue glue were used to close the varicose veins. Balloon tamponade was used when massive bleeding occurred.
4
TIPS Procedure: Transjugular Intrahepatic Portosystemic Shunt
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All TIPS procedures were performed according to previously described protocols.7 (link),8 (link) Briefly, hepatic vein catheterization was performed through the right internal jugular vein using a transjugular liver access set (RUPS-100; Cook Medical). When the portal vein was punctured by the TIPS needle, a hydrophilic guidewire (Terumo) was gradually advanced to the portal, splenic, or superior mesenteric vein. The Viatorr stent (Gore, Inc.) was in short supply in our center, and an 8-mm bare-metal stent (E-luminexx or Lifestent; Bard, Inc.) combined with an 8-mm expanded polytetrafluoroethylene-covered stent (Fluency; Bard, Inc.; or Viabahn; Gore, Inc.) was placed in the intrahepatic tract after dilation with a balloon catheter. The portal pressure gradient (PPG) was measured in every patient before and after TIPS creation, and the target of post-insertion TIPS PPG was less than 12 mmHg, or a decrease from the initial PPG >50%. Cyanoacrylate and/or coils were used to embolize the gastric varices when they were found on portal or splanchnic venography. Technical success was defined as successful creation of a shunt between the hepatic and intrahepatic branches of the portal vein.9 (link)
5
Transcatheter Leak Occlusion Procedure
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A 6-French (6-F) access was obtained in the femoral artery and vein separately. The right atrium systolic pressure was recorded with a 6-F multipurpose catheter (Medtronic, Minneapolis, USA). Under the guidance of a 5F JR 4.0 or Cobra catheter (Medtronic, Minneapolis, USA), the arteriovenous loop was established with a 260 cm, 0.035 inch, hydrophilic guide wire (Terumo, Tokyo, Japan) by crossing both the leak and the Cabrol’s shunt and subsequently advancing into the right atrium and then snaring and exteriorizing from the femoral vein. Then the delivery sheath (6- to 8-F according to the device size) crossed the leak in retrograde approach. The occlusion device with appropriate size determined by AAL size and shape, was introduced alongside the loop, and carefully deployed across the leak. When the technical success was obtained, the loop guide wire could be was removed and the occluder was finally released (Figure 2A,B ).
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