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Catheter Cardiovasc Interv. 2019 Mar 1;93(4):673-677. doi: 10.1002/ccd.28022. Epub 2018 Dec 13.

Ex-vivo percutaneous bypass: Limb perfusion in the setting of occlusive large bore sheath.

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School of Medicine, Wayne State University, Detroit Medical Center, Detroit, Michigan.
MedStar Washington Hospital Center, Washington, District of Columbia.
St. John Hospital and Medical Center, Detroit, Michigan.


Successful cardiac catheterization procedure begins with safe vascular access and ends with effective hemostasis after equipment removal. These new and advanced technologies in the cath lab require large-bore arterial accesses. Large-bore sheaths are associated with blood flow obstruction resulting in limb ischemia. In this case we present a 48-year-old woman was admitted NSTEMI and cardiogenic shock requiring mechanical circulatory support. Selective left common iliac angiography demonstrated obstructive flow at the level of the left CFA (access site). Therefore, ipsilateral bypass circuit was done. The current case illustrates the utility of a temporary ex-vivo bypass circuit to preserve limb perfusion in the presence of an occlusive large bore sheath. The technique permits sufficient hemodynamic support while maintaining limb perfusion and can be used for any occlusive large bore sheath.


cardiogenic shock; coronary artery disease; mechanical circulatory support; peripheral vascular disease


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