Key result
The wire countertraction ('body flossing') technique was successful in all 10 attempted cases of venous stenosis or tortuosity during cardiac device procedures, with no complications.
Why the study?
Venous stenosis and tortuosity challenge CIED procedures, prompting an assessment of the feasibility, safety, and efficacy of the wire countertraction body flossing technique for sheath placement.
Does the wire countertraction ("body flossing") technique facilitate safe and effective sheath placement in patients with venous stenosis or tortuosity during cardiac device procedures?
Observational (n=10)
Does the wire countertraction ("body flossing") technique facilitate safe and effective sheath placement in patients with venous stenosis or tortuosity during cardiac device procedures?
The wire countertraction ("body flossing") technique is a safe and effective alternative for overcoming venous stenosis and tortuosity during cardiac device procedures when standard sheath advancement fails.
May facilitate sheath advancement in tortuous or stenotic veins during device implantation; hypothesis-generating and needs prospective validation.
BACKGROUND: Innominate vein stenosis and venous tortuosity are common findings during cardiac implantable electronic device upgrades or replacements and present a challenge to the implanting physician. Various techniques have been described to facilitate lead placement, including serial dilation, balloon venoplasty, and percutaneous access medial to the stenosis, each with its own benefits and risks. OBJECTIVE: The purpose of this study was to assess the feasibility, safety, and efficacy of the wire countertraction ("body flossing") technique to facilitate sheath placement through tortuous and stenotic vessels. METHODS: Patients undergoing cardiac implantable electronic device procedures requiring the body flossing technique due to inability to place vascular sheaths over the wire through stenoses or tortuosity were retrospectively analyzed. Clinical characteristics, procedural equipment, and outcomes were analyzed. RESULTS: Simultaneous countertraction was successful in all attempted cases, including 8 patients with stenoses and 2 with tortuosity. In 2 of the stenosis cases, venoplasty had previously failed. No complications occurred. CONCLUSION: Simultaneous countertraction (body flossing) is an effective tool to overcome venous stenosis and tortuosity that are amenable to wire advancement but not to vascular sheaths. It seems to be a safe and effective alternative to other techniques used in these scenarios.
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Arkles et al. (2020) conducted an observational in Innominate vein stenosis and venous tortuosity during cardiac implantable electronic device procedures (n=10). Wire countertraction ('body flossing') technique was evaluated on Procedural success. The wire countertraction ('body flossing') technique was successful in all 10 attempted cases of venous stenosis or tortuosity during cardiac device procedures, with no complications.
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