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Technical Issues in Coronary and Peripheral Procedures

PanVascular Medicine

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Abstract

The term “technical issues” in the title could be broadly defined to include all “pan vascular” procedural techniques, as well as applied science related to catheter and device designs. However, this would exceed the scope of any single chapter. Accordingly, for the purpose of this review, we will focus on the critical core knowledge needed to enhance the safety and success of angiography while also orienting the operator to relevant unique bioengineering traits of other assets within the angiographic suite. Specifically, technical fundamentals for each stage of angiography from access to hemostasis will be reviewed while highlighting technical pearls along the way. In addition, there will be an introduction to catheter and device bioengineering to illuminate product design properties that may enable the physician to predict product performance in specific clinical scenarios. Sprinkled throughout the discussion are reminders of important milestones in the history of innovation that help the reader better understand the evolution of the art and catheter/device nomenclature. Finally, we will highlight the technical issues of radiation physics including review of the indolent often clinically silent impact of direct x-ray exposure on the patient and radiation scatter on the staff.

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Abbreviations

Flexibility:

An indication of the bending stiffness of the material. The flexural modulus is a coefficient of elasticity which represents the ratio of stress to strain as a material is deformed under dynamic load.

Internal diameter (ID):

Internal diameter of a catheter. Generally measured in inches for a catheter and in French size for a sheath. Note: Sheath sizes are labeled based on ID. ”

Kink resistance:

Refers to the ability of a tube to withstand bending and coiling without deforming or “kinking”. Kinking weakens the structural strength of the tube and can block or slow the transference of media or devices. Kink resistance is to a large extent a function of wall thickness and shore hardness.

Lubricity (coefficient of friction):

Measures the frictional properties or tackiness of material. A low coefficient of friction is usually desired in medical applications to minimize bodily trauma and tissue irritation.

Outer diameter (OD):

Outer diameter of a catheter. Generally measured in French size although microcatheters are often measured in millimeters. Note: “Catheter sizes are labeled based on OD. ”

Shore hardness:

The relative resistance of a material’s surface to indentation by an indenter of specified dimensions under specified load. Shore hardness refers to the general stiffness of a material. Hardness is measured according to the durometer and Rockwell scales.

Tensile strength:

Tensile properties are a measure of the force required to stretch a plastic and the percent of stretching the plastic can withstand before breaking. Ultimate tensile strength is the maximum stress a material withstands at the point of rupture. A good tensile strength allows for design of thinner wall thicknesses, which result in smaller diameters. A high tensile strength also aids in ease of catheter insertion. Related to this is ultimate elongation, which is the total elongation by percentage of a sample at the point of rupture.

Torque:

A measure of force related to the rotational stability of the tube. If rotated at one end, a tube with a high degree of torque will rotate at nearly the same ratio at the other (untouched) end. A high degree of torque can be desirable in invasive applications. Braiding of tubes is a method used to increase torque.

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  • Baim DS, Grossman W (2006) Grossman’s cardiac catheterization, angiography, and intervention. Lippincott Williams & Wilkins, Philadelphia

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  • Valji K (2006) Vascular and interventional radiology. Saunders Elsevier, Philadelphia

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Authors and Affiliations

  1. CAMC Vascular Center of Excellence, West Virginia University Department of Surgery, West Virginia University School of Medicine, 3200 MacCorkle Avenue SE, 25304, Charleston, WV, USA

    Prof. Mark C. Bates M.D., D.Sc. (hon) (Professor of Medicine and Surgery, Co-Director CAMC Vascular Center of Excellence)

  2. CAMC Vascular Center of Excellence, West Virginia University School of Medicine, 3200 MacCorkle Avenue SE, 25304, Charleston, WV, USA

    John E. Campbell M.D.

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    Peter Lanzer

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Bates, M.C., Campbell, J.E. (2013). Technical Issues in Coronary and Peripheral Procedures. In: Lanzer, P. (eds) PanVascular Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37393-0_38-1

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  1. Latest

    Technical Issues in Coronary and Peripheral Procedures
    Published:
    28 June 2016

    DOI: https://doi.org/10.1007/978-3-642-37393-0_38-2

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    Technical Issues in Coronary and Peripheral Procedures
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    DOI: https://doi.org/10.1007/978-3-642-37393-0_38-1

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