SnaringTuohy-Borst with Side ArmBrachial accessPalmaz stentEvaluating proximal dialysis access
This chapter discusses some techniques and tricks that are helpful for all vascular surgeons and interventionalists.
Snaring
Snaring is effective in removing retained and foreign objects from the vascular system. Occasionally snaring a wire is needed to achieve through-and-through wire “body floss” for stability and support. Snares and microsnares come in a variety of shapes, lengths, and diameters. They can be angled, and the loop snare can consist of one loop or multiple loops. The diameter of the loop also can vary: Removing a retained object from the tibial artery, for example, requires a microsnare (Fig. 36.1), but a bigger loop is needed to snare a retained wire in a large vessel. Successful snaring requires two individuals who are familiar with the technique and the device. For example, assume a wire is being snared to allow going up and over the aortic bifurcation. First, advance the snare and its catheter into the optimal spot where the wire can be advanced to be captured (Fig. 36.2). Then open the snare and the leaflets. (Often the snare must be rotated to free the leaflets and ensure that they are wide open and not trapped by the vessel wall.) Then advance the wire to be snared through the snare loop. Keeping the wire in its place, pull back on the snare while advancing the catheter to tighten the snare. See if the wire is captured. If not, then redo the steps. An oblique image might be helpful to make sure that the snare loop and the wire are in the correct position. Once the wire is captured, tighten the snare on its catheter by tightening the torque device. Then pull the snare, catheter, and wire as one system, making sure that the individual handling the wire is no longer holding onto the wire; otherwise the wire will slip out of the loop.
Only gold members can continue reading. Log In or Register to continue
