Case 49: PCI Manual - Guide catheter kinking

[@drgaganvelayudhan1733]

One technique that I've used as a last resort was with a 5F pigtail from the opposite femoral. This was for a broken catheter tip in the arch of aorta which appeared stuck in the walls of the aorta. It was impossible to snare since both ends were stuck against the aortic walls.The pigtail catheter was straightened with a guidewire and brought in proximity to the broken tip. On carefully removing the guidewire the pigtail took its normal curve and hooked automatically onto the broken catheter tip. We managed to dislodge the catheter tip and brought it much further down into the abdominal aorta. There using a snare it was brought out successfully. Very crude technique, but it saved the day!

[@alialdujeli4151]

Thank you so much , I check your channel eachday , waiting for your cases .

[@jaymohan5359]

Hello! Thank you so much for your videos! As an IC fellow they are very helpful. Question- in your algorithm for catheter kinking you mention using the indeflator device to assist in unkinking. I’ve never heard of this technique. Can you explain how to do this?

[@drgaganvelayudhan1733]

This is meant for mild cases of kinking. You connect the indeflator device directly to the catheter hub and give pressure slowly. The dye forcing ahead should help to relieve the kink a little bit, this may help in pushing a guidewire through. As mentioned in the video above, extreme cases of kinking may not be relieved with this technique.

[@tuanhoanh1198]

In several cases, i advanced guiding catheter into aorta and tried to untwist the guide according to the first step in your proposal algorithm with a wire (0.035'', 0.014''). Of course the wire usually failed to cross the twisted segment of the guiding but after several attempts of doing so, i managed to pull the guiding catheter out of the sheath

[@mohammadjaber6387]

Thank you sooooo much for short and up to point videoes

[@nctbkh3718]

Thank you for your sharing. There are some useful informations and clues for managing catheter kinking

[@arminmarashizadeh5540]

Hi dear professor Manos, in your algorithm the fifth step was pull knot through skin, but in what not to do part you mentioned do not pull back the kinked catheter through skin, can you please explain the difference pls?

[@manosbrilakis]

Pulling the knot through the skin should be the last step if everything else fails, due to the risk for injuring the femoral artery.

[@tahersalman6698]

Thanks Manos Brilakis

[@TheNEF11]

thank you very much for the lesson