AV PTA Portfolio Flashcards
Percutaneous
through the skin
Transluminal
through the lumen (vessel)
Angioplasty
reopens narrowed blood vessels and restores
Intimal Hyperplasia is a response to what?
injury to the blood vessel
What is the result of intimal hyperplasia?
formation of a neo-intima over the site of injury
What accelerates intimal hyperplasia?
the presence of prosthetic material in the blood vessel
Intimal hyperplasia may result from:
endovascular intervention, or turbulent flow
Re-stenosis occuring 3-12 months after an angioplasty is typically due to:
Intimal hyperplasia
Early thrombosis of a fistula is most often due to ________, while late thrombosis tends to be due to _________.
an inflow problem, an outflow stenosis
Failed PTA in hemodialysis includes:
- 30% residual stenosis
- “flow limiting” dissection
- abrupt closure
- vessel rupture
- additional thrombus
If you have resistant stenosis:
use a high pressure balloon
elastic stenosis definition
balloon can efface waist, but lesion returns
What is reccomended for elastic stenosis?
- prolonged high pressure PTA
- 5 minutes, 2 cycles
Proper PTA techniques
- same diameter as vessel
- only dilate diseased segments
- slow inflation
- prolonged dialation
- stenosis < 30%
Balloon material design
- puncture resistance
- trackability
catheter design
- inflate/ deflate time
- trackability
- pushability
tip design
- trackability
- crossability
- pushability
the diameter of a non compliant balloon will:
stay consistent regardless of pressures
the diameter of a semi-compliant balloon will:
grow beyond labeled diameter
What is barotrauma?
physical tissue damage caused by a pressure difference between an unvented space inside the body.
What percentage of the balloon should focus on its pressure on the lesion?
100%
ultra non-compliant composite balloons
- only 1% of growth from nominal to RBP
- reduced chance of over expansion
- the maximum dilation force is concentrated at the lesion site
- Dorado, Conquest/40, Atlas/ Gold Balloon Catheters
Conquest Overview
first ultra non-compliant fiber balloon
Atlas overview
ultra non-compliant, large diameter, fiber balloon
Dorado overview
first and only fiber balloon offered in longer lengths
atlas gold overview
next generation, large diameter, fiber balloon
Conquest 40 overview
first and only fiber balloon up to 40 ATM
Presto 40 ATM Inflation device
- pressures up to 40 ATM
- larger 30cc barrels allows for rapid and easy deflation
- ergonomic handle
- fills up to 24 x 40 mm Atlas Gold
Conquest Balloon Catheter
- ultra non-compliant
- RBP up to 30 ATMs
- wide range of sizes
- 5- 12 mm diameters
- 2- 8 cm lengths
- 50, 75, & 120 cm catheter shafts
- co-axial shaft
conquest 40 balloon catheter
- ultra non- compliant
- RBP up to 40 ATMs
- tampered tip compared to conquest
- 4-12 mm diameters
- 2-10 cm lengths
- shaft size optimized for inflation/ deflation
-stent indication - co-axial shaft design
conquest 40 is reccomended for use in:
- Percutaneous transluminal angioplasty in the femoral, iliac, and renal arteries and for the treatment of obstructive lesions of native or synthetic arteriovenous dialysis fistua
- post dialation of stents and stent grafts
The conquest 40 is not for use in the:
coronary arteries
Dr. Vesely Case study
- angioplasty baloon inflation pressures during treatment of hemodialysis graft-related stenosis
- 34% of grafts and veins
Dr. Trerotola case study
- prospective study on balloon inflation pressures and other technical aspects of hemodialysis access angioplasty
- 20% of fistula
Dr. Rajan case study
- ultra high pressure vs. high pressure angiolasty treatment of venous anastomotic stenosis in hemodialysis grafts: is there a difference in patency?
- 13% of grafts
Dorado balloon catheter
- proprietary composite balloon technology on a hybrid catheter
- multiple indications; post-stent dialation claim
- ultra non-compliant
- puncture resistant
- checker flex points
what is the CHECKER balloon process?
a proprietar manufacturing process that creates a pattern of flex points on the tightly wrapped balloon
Impacts of the CHECKER balloon process:
- improved trackability
- reduced crossing profile
- reduced balloon guard removal resistance
Dorado Balloon catheter range of sizes
- 3-10 mm diameter
- 2-20 cm length balloons
- 40, 80, 120, 135 catheter lengths
- 30/70 “contrast to saline”
Dorado catheter features
- low profile
- high rated burst pressure and burst range
- range of sizes
Vaccess Balloon Catheter quick notes
- OBLs or outpatient lab facilities only
- low cost high pressure balloon
Vaccess Balloon Catheter features
- non- compliant hemodialysis access balloon catheter with fixed hub
- coaxial shaft and short tip design
- designed for access centers
Vaccess balloon Catheter sizes
- 4-12 mm diameters
- 2- 8 cm balloon lengths
- 50 and 80 cm catheter lengths
Atlas Balloon catheter
- ultra non-compliant
- very low profile
- co-axial shaft
- designed for low- and- high pressure use
- largest working range (12 ATMs)
Atlas balloon catheter sizes
- 12- 26 mm diameters
- 2, 4, 6 cm lengths
- 75 & 120 cm catheter lengths
The biggest difference between the atlas and the atlas gold are the:
shorter shoulders on the atlas gold
Atlas gold balloon catheter
- short shoulders
- reduced tapered tip
- improved trackability
- designed for low- and high- pressure use
- largest working range (12 ATMs)
Ultraverse 035 catheter design
- OTW
- semi-compliant
- dual lumen
- GeoAlign Marker system
- Checker flex points
key sales messages- ultraverse 035
- 3-12 mm diameters
- 20- 300* mm lengths
- up to 8 x 80* through a 5Fr. sheath
- 75 & 130 cm catheter lengths
What is the GeoAlign marker system?
non- radiopaque markings on the catheter shaft
GeoAlign marker system features
- 1 cm increments
- every 10 cm is labeled with distance from distal balloon tip
- thicker bands denote the mid-way point (5 cm) between labeled distances
GeoAlign Messaging
- designed to facilitate repeatable catheter alignment at the lesion
- designed to increase procedure efficiency by minimizing fluoroscopy exposure by 27% average in pre-clinical study
Boston Scientific .035 PTA Competition
- Mustang
- Gladiator
Boston Scientific Mustang
- high pressure, non- compliant, low-profile, excellent trackability
- up to 24 ATM (7- 9 mm ranging 20-18 ATM)
- NyBax balloon material
- 5fr sheath up to 7mm x 200 mm, 6 fr sheath 8-10 x 80 mm, 12 mm 7F
- dual lumen
- mediglide coating
Boston Scientific Gladiator
- high pressure, non-compliant, low profile, excellent trackability
- same features as mustang
- low cost alternatives for access centers
Boston Scientific Mustang profile trade-offs
fiber-based balloons are designed to avoid circumferential ruptures but require more material-often increasing profile
Calcified lesions: Dorado IFU
no calcium of graft precaution
Calcified lesions: Conquest IFU
no calcium or graft precaution
Calcified lesions: Mustang IFU
use with caution for procedures involving calcified lesions or synthetic vascular grafts due to the abrasive nature of these inflation sites
Boston Scientific Gladiator size offerings
- diameters: 3-10, 12 mm
- balloon lengths: 20, 30, 40, 60, 80, 100, 120, 150, 180, 200 mm
- catheter lengths: 40, 75, 135 cm
- sheath size: 5, 6, 7F
Boston Scientific Gladiator pressure offerings
- nominal: 3-12 ATM
- RBP: 14-24 ATM
Boston’s Athletis balloon
- Vectran braided balloon design enables optimized deliverability and ultra high pressures up to 40 ATM
- the unique, non-compliant balloon design enables it to open to the stated diameter even in highly resistent lesions
Boston’s Athletis balloon trackability
- lower profile tip by 24% to conquest 40
- both have RBP of 40
- conquest 40 takes 16% more force to track to to stenosis
- more non- compliant
Ultra non-compliant balloons have a growth factor of _____% or less
1
What PTA Balloon is our Large Diameter PTA balloon? (Select all that applys)
- Atlas
- Atlas Gold
Conquest 40 offers a rated Burst up to how many ATM’s?
40
The GeoAlign® Marker System offers a _____ % reduction in fluoroscopy time.
27
What are two major improvements that were made to Conquest® 40 as compared to the original Conquest? (Select all that apply)
- tampered tip
- higher ATM ratings
Which PTA balloon offers an ultra non-compliant balloon with Checker Flex Points, 3-10 mm and 40, 80, 120, 135 catheter lengths?
Dorado
What are some key benefits to the Presto 40 inflation? (Select all that apply)
- Pressure rating up to 40 atm
- Larger 30cc barrell
- Ergonomic handle
- Fills up to 24x40 Atlas Gold Catheter
Succesfful PTA treatment is characterized by (Select all that apply)
- No significant residual stenosis (>30%)
- The waist of the balloon is effaced
- Thrill is restored in the access site
- Patient is able to resume dialysis
