Pigtail catheter

Abdominal aorta - Injection of 15 cc/s for 30 cc (pigtail catheter). This step allows for identification and assessment of patency of the celiac axis and SM A, and it helps guide proper visceral catheter selection. For SMA and celiac vessels that have acute angles, reverse curve catheters such as the Sos-Omni (Angiodynamics, Queensbury, NY) or Simmons (Cook, Bloomington, IN) can be utilized. Otherwise, C-shaped catheters may be routinely used. 

The common angiographic catheter is an important tool for lead extraction. One such catheter is the conunon angled pigtail catheter. This catheter can be used to retrieve and position electrodes by the femoral approach. Other catheters used to assist in lead extraction include a right Judkin s coronary catheter, multipurpose coronary catheter, and Amplatz catheter (Microvena Corp., White Bear Lake, MN). The catheters are usually passed femorally through a sheath. 

There are three fundamental anatomic approaches for lead extraction (23,24,37). The first is retrieval by the implant vein, frequently called the superior approach. This approach can include simple traction. Buck s traction, the use of locking stylets with traction, or the use of locking stylets with countertraction sheaths. The second approach is transfemoial, frequently called the inferior approach. This approach may involve several distinct techniques. When this involves entangling a lead with a pigtail catheter, the catheter is passed from below. When free open ends present themselves, a wire-loop system may be used with traction. Both the Dotter retriever and Dormia basket may also be applied for traction from below. Finally, the lead to be removed may be extracted by the Byrd Femoral Work Station with the use of a combination of snares and wire loops. The third and final approach is retrieval of leads by a limited thoracotomy. 

Fig. 6.21 Femoral lead extraction using a pigtail catheter to remove the lead. (From Espinosa RE, Hayes DL, Vhetstra RE, et al. The Dotter retriever and pigtail catheter efficacy in extraction of chronic transvenous pacemaker leads. Pacing Clin Electwphysiol 1993 16(12) 2337-2342, with permission.)...

Taliercia CP, Vlietstra RE, Hayes DL. Pigtail catheter for extraction of pacemaker lead. (Letter) J Am Coll Cardiol 1985 5 1020. 

Maisch B, Ertl G, Kurke H. Extraction of a chronically infected endocardial screw-in pacing lead by pigtail catheter and wire loop via the femoral vein. PACE 1983 8 230. 

A nephrostomy may become displaced if not adequately anchored to the skin. Even with a firm skin attachment, an obese patient will frequently ease a nephrostomy out of a kidney by simply turning in bed. For this reason self-retaining pigtail catheters are preferred. 

Fig. 7.6. a A Fistula after partial cystectomy for carcinoma of the bladder. The pelvicaliceal systems are not dilated. Bilateral punctures at 5-8 min after intravenous injection of contrast medium to secure guidewires. b Bilateral pigtail catheters with blind ureteric tails to inhibit ureteric flow... 

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