Experience with the novel unifemoral parallel sheath technique in percutaneous intervention of chronic total coronary occlusions

Abstract

Background Percutaneous interventions to address chronic coronary occlusions (CTO-PCI) often require simultaneous ipsi- and contralateral coronary injections. Although radial access is increasingly popular, bifemoral artery access is still the preferred choice of CTO operators. The aim of this case series is to demonstrate the feasibility and safety of the unifemoral parallel sheath technique, which avoids two puncture sites, increases patient comfort, and improves procedure ergonomics. It offers rapid second access to the femoral artery adjacent to the first sheath as well as closure by unilateral manual compression without or with 1 or 2 vascular closure devices. Results We retrospectively evaluated the procedure results in 90 consecutive CTO patients where an ipsilateral parallel sheath access was considered. Placement of the second sheath uneventfully failed in two because of severe femoral calcification and narrowing. In 96.6%, the first sheath was 7 F (3.4% 6F), while the second sheath was 4 F in 22.7%, 5 F in 64.7%, and 6 or 7 F in 11.4% each. No major complications nor severe bleeding events occurred, and the mean drop of hemoglobin was low (0.6 g/dL ± 0.86). Conclusion In CTO-PCI requiring contralateral coronary injections or the retrograde technique, the ipsilateral parallel sheath technique might be a feasible alternative to the standard bifemoral or femoral-radial access.

Controlled flow reduction of an iliacoportal shunt graft for portal vein arterialization in a pediatric patient

“…After numerous attempts at entering the vascular graft from crossover remained unsuccessful, the right common femoral artery was punctured twice more, distally. A transfemoral parallel sheath technique has been previously described in 90 adults undergoing the treatment of chronic coronary occlusions, showing that this technique is feasible and safe in most patients [ 7 ]. We used two sheaths in a line with the second more distal than the first and showed that this approach is technically feasible in a pediatric patient with no access-related complications.…”

Microcatheters for antegrade recanalization of chronic total coronary occlusions: Feasibility and safety of the corsair - A retrospective registry-based single operator experience

“…All but 12 patients were approached via the same femoral artery employing the parallel sheath technique. 11 …”