Vessel approach techniques

Question 1

Sones technique

Answer 1

• Direct approach
• Cut-down technique → direct visualization of the vessel → puncture → KT directly advanced in vessel
  o Arteries: pulsatile, silvery/white color
  o Veins: non pulsatile, darker color, smaller
• Rommels can be used to expose vessel

Question 2

Classic Seldinger technique

Answer 2

o Double wall entry = original Seldinger technique
 Through and through puncture → draw back of needle until flashback of blood

Question 3

Modified Seldinger technique

Answer 3

Arterial puncture
o Single anterior wall entry = modified Seldinger technique
 Arterial needle puncture into femoral artery at 30-45
* Valsalva maneuver during puncture: can help to distend veins
 Once blood → introduce J-tip guidewire → remove needle
 Introduce KT over guidewire

Question 4

KT size refers to

Answer 4

outer diameter

Question 5

Sheath size refers to

Answer 5

inner lumen

Question 6

Blood vessel repair techniques

Answer 6

• Finger pressure applied 5min/sheath size (ie. 5F = 25min), usually 10-15min is enough
  o 4 periods: Full pressure → ¾ pressure → ½ pressure → ¼ pressure
• Puncture closing devices:
  o VasoSeal, SureStat: resorbing hemostatic plug to outer wall of vessel
  o AngioSeal: rectangular absorbable anchor (absorbable suture material) in inside of vessel + collagen plug on outside
  o Duet device: liquid procoagulant mixture in soft tissue outside of artery
  o Matrix VSG system: 2 component gel that solidifies skin + adhere to outside of artery
  o Prostar: sheath like through margin to perform suture mediated closure