Transcaval Access
From Bay Area Structural Heart Wiki
Used for TAVR access when the Iliacs and/or Femorals are insufficient for large-bore access.
Catheters
- 6fr Straight pigtail
- 7fr RDC guide catheter
- 6Fr JR guide catheter
- NaviCross
- Piggyback wire converter
- Small curl Agilis
- TorqView Delivery catheter (Any size - use first to expire)
- Use threaded delivery cable only
- DrySeal sheath (Ask for size)
Wires
- Grandslam wire
- Astato wire
- Lunderquist wire
Misc. Supplies
- (2) Watchdogs
- (2) Stopcock
- Bovie Pen
- (2) hemostats for Bovie pen
- Grounding pad
- 25mm Gooseneck snare
- Perclose (for 8Fr RFV)
Check for closure type and size to make sure we have in stock before case
- Procedural info:
- 6 Fr Sheath RFA or LFA (depending on PAD) FA
- 8 Fr RFV -Preclose
- 7Fr 55cm RDC Guide with watch dog and stopcock attached inserted into 8 Fr sheath
- 6 Fr JR4 Guide with watch dog and stopcock inserted into 6 Fr sheath FA
- 24mm gooseneck snare inserted into JR4 Guide FA
- Astato wire (shape by physician) with piggyback loaded into the Navicross with the back end attached to bovie tip with two hemostats (take bovie tip out of pen and give to physician) inserted into & 7 Fr 55cm RDC Guide
- Bovie programmed to cut 30
- Bovie from inferior vein cava into abdominal aorta
- Snare Astato wire and push up to ascending aorta
- Remove Astato and piggyback leaving Navicross in place
- Lunderquist advanced into Navicross
- Navicross and 8 fr sheath removed
- 18-22 dryseal advanced over lunderquist
- Proceed with normal TAVR Closure :
- 6 fr straight pig inserted into 6 fr sheath
- Agilis advanced into Dryseal
- Grand slam inserted as a back up wire (Have Piggy back and Navicross ready just incase of failed closure )
- Torqview 180 with closure device loaded inserted into Agilis
- Closure device deployed with grand slam still across fistula
- 10 for 10 injection through pigtail
- Grand slam removed
- Agilis removed
- Dryseal removed
