title: Three new techniques for creation of a steerable sheath, a 4F snare, and bidirectional sheath inversion using existing endovascular materials.
abstract: We present three novel techniques for creation of (1) a steerable sheath, (2) a 4F snare device, and (3) dual anterograde and retrograde double-wire percutaneous transluminal angioplasty access technique using a single femoral puncture. These techniques were conceived and bench-tested in our institution, allowing the utilization of inexpensive equipment for complicated endovascular procedures. They offer (1) controlled navigation, no-touch vessel cannulation and cannulation of angulated vessels, contralateral limb of stent grafts, fenestrations, and branches; (2) a low-profile (4F external diameter) modifiable snare with the ability to expand to the size of an entire aneurysm and the ability to undo the snare in case of blockage with other endovascular material; and (3) in situ sheath inversion for concomitant anterograde and retrograde percutaneous angioplasty with a single femoral puncture.
authors: Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris, France. alexandrosmallios@gmail.com
authors: Alexandros
authors: A
authors: Mallios
authors: Willy
authors: W
authors: Yankovic
authors: Benoit
authors: B
authors: Boura
authors: Myriam
authors: M
authors: Combes
mesh_terms: D000783:Aneurysm / Q000601:surgery*; D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods*; D057785:Catheters; D057510:Endovascular Procedures / Q000295:instrumentation* / Q000379:methods*; D004867:Equipment Design; D005263:Femoral Artery; D006801:Humans; D011474:Prosthesis Design; D011677:Punctures