Deflecting wire

The Byrd Workstation helical loop basket and tip-deflecting wire guide (Fig. 4.15). Components included in the Byrd Workstation are (a) 16-F workstation check-flow introducer sheath set (b) 12-F straight inner femoral sheath (c) helical... 

Fig 4 15 Byrd Workstation femoral intravascular retrieval set 16-F sheath containing a coaxial 12-F inner sheath preloaded with a Dotter helical loop basket and a tip-deflecting wire guide... 

Helical loop-basket and tip-deflecting wire guide... 

An alternative to the basket and tip-deflecting wire is the Needle s Eye snare (Fig. 4.27). This extraction tool can be inserted through and used in conjunction with the Byrd Workstation [23]. This, too, is a transfemoral grasping tool that forms a basket snare around the lead body. It is delivered to the vicinity of the lead through a long, flexible, 12-F cannula placed coaxially within a larger outer cannula that has a hemostasis valve at its proximal end. The flush port is continuous with the snare s innermost lumen. The Needle s Eye snare is designed to... 

Fig 4, 26a-d Removal of lead using the Byrd Workstation, tip deflecting wire and basket... 

Fig 5.8 Temporal-sequence fluoroscopic images showing (a) the atrial lead being grasped by a tip-deflecting wire inserted through a transfemoral approach, (b) proximal end of the lead now intravascular... 

Transfemoral approach with a tip-deflecting wire or steerable catheter in order to catch the lead in the region where the lead is free (in the right atrium if the lead slips through the adher-ences in the innominate vein if the lead does not slip into the adherences) and to make the proximal end intravascular and free floating. It is important to catch the lead as near as possible to the proximal end, where only insulation is present (Fig. 5.11). 

Fig 5 11 Fluoroscopic images showing the next two steps in the case in the Figure 5.8 (a) atrial-lead-grasping maneuver using a tip-deflecting wire inserted via the transfemoral approach (b) proximal end of the lead, now intravascular, is then caught by a lasso... 

Inner sheath plus deflecting wire plus Dotter retriever Curry snare... 

The use of a deflecting wire and Dotter retriever is ideal when the lead to be removed has no free end. This system enables the creation of a loop around the lead to be extracted and, ultimately, retraction of the lead into the femo-... 

Fig. 6.23 The Byrd Femoral Work Station, (a) The sheath is seen with its preloaded inner sheath containing a deflecting wire with wire-deflecting handle and Dotter retriever. The Check-Flo valve and side-port are also shown, (b) The distal end of the Byrd Femoral Work Station showing the outer sheath, preloaded inner sheath, Dotter basket, and tip-deflecting wire. (Photographs courtesy of Cook Pacemaker Corp.)...

Fig. 6.24 Illustration of the Byrd Femoral Work Station inserted by the right femoral vein. The relationship of the Byrd femoral sheath, preloaded inner sheath with its Dotter retriever, and handle-activated deflecting wire are shown. (From Belott PH. Endocardial lead extraction A videotape and manual. Armonk, NY Futura Publishing, 1998, with permission.)...

Simple catheter relocations can be performed with a forceful injection of saline, insertion of guidewire, or transfemoral relocation (Olcott et al. 1989). A transfemoral catheter relocation involves a common femoral vein puncture and the placement of a tightly curved catheter, reversed curved catheter, or catheter with a tip deflecting wire to engage the malpositioned catheter and draw it back into the right atrium. These techniques are used when the catheter length is deemed appropriate and does not need modification. 

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