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Quantifying the Geometry of Vascular Access

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Quantifying the Geometry of Vascular Access Quantifying the Geometry of Vascular Access Background Femoral Artery Access The human vasculature has been accessed with Femoral Artery Access included percutaneous minimally invasive techniques for almost 100 years. access through the femoral artery in the groin. The first procedure to use this technique was, a Femoral artery access is typically used for cerebral angiogram, performed by Dr. Egas Moniz diagnostic angiograms, angioplasty, stenting, and in Portugal in 1927 [1]. With advances in embolization. technology, these procedures are now performed Peripherally Inserted Central Catheter (PICC) Line for therapeutic as well as diagnostic purposes. Access Millions of patients are treated with these Peripherally Inserted Central Catheter (PICC) Line procedures in the United States each year. Access included percutaneous access through a Vascular access is commonly obtained at arterial vein in the arm in the region just above the elbow. and venous locations in the legs, arms, and neck. A wire and catheter were advanced until the Accurate anatomical models from the access site to internal tip of the catheter was in the superior vena the treatment location are critical in evaluating the cava. The purpose of the catheter is to deliver performance of the devices used in these intravenous therapy. procedures. This paper will focus on quantifying Jugular Vein Access – Line Implant the geometry of the vascular access site for several Line Implant Jugular Vein Access included different minimally invasive procedures. percutaneous access through the interior jugular The vascular access geometry is an important part vein in the neck. A wire and catheter were of the anatomical model because as a device is advanced for therapeutic purposes. introduced into the vasculature, the device will be Femoral Arteriotomy Access subjected to additional tortuosity. The tortuosity of Femoral Arteriotomy Access included gaining the access site will depend on the access location arteriotomy access from a femoral cut-down and whether the access is percutaneous or “cut- approach. Wires, catheters, and access sheaths down”. An anatomical model representative of containing endovascular components were clinical conditions is critical for patient-risk- advanced to the target treatment sites. Digital mitigation testing such as simulated-use testing, photography was used to measure the angle of the particulate counting, and pre-conditioning for arteriotomy to the sheath/device. durability testing. Femoral Vein Access Methods Femoral Vein Access included percutaneous access This paper presents the measurements of several through a vein in the groin. A wire and catheter access locations for commonly used procedures. were advanced for diagnostic purposes to evaluate Ultrasound (US) imaging was used to quantify the patency, thrombus, and stenosis. Sheaths and vessel inner diameter, vessel depth, and the angle catheters were advanced to perform thrombolysis, of the access device (e.g. needle, catheter, sheath, angioplasty, and stenting. etc.) relative to the vessel. Data were obtained from multiple physicians and a total of ten patients Results per procedure type were included. The access Representative US images associated with the locations that were measured are described below. Femoral Artery Access measurements are shown in Figures 1 through 3. The measurements included: www.medinstitute.com INSTITUTE 765.463.1633 MED Quantifying the Geometry of Vascular Access femoral artery depth, artery internal diameter and access angle with a 5 Fr sheath. Sheath access angle relative to vessel Vessel Depth 5 Fr Sheath Vessel Vessel Diameter Figure 3. Representative longitudinal US image of 5 Fr sheath access angle relative to femoral artery Figure 1. Representative cross-sectional US image of femoral A summary of the measurements for femoral artery showing vessel depth and vessel diameter artery access, PICC line access, and jugular line measurements implant are shown in Tables 1 through 3. Vessel Depth Vessel Figure 2. Representative longitudinal US image of femoral artery showing vessel depth measurement www.medinstitute.com INSTITUTE 765.463.1633 MED Quantifying the Geometry of Vascular Access Table 1. Femoral artery access measurements Access Device Angle Number of Vessel Depth Vessel Measurement Measurements (mm) Diameter (mm) Needle Angle Sheath Angle (deg) (deg) Mean 21 9 137 145 10 SD 6 1 10 7 Table 2. PICC line access measurements Vessel Access Device Angle Number of Vessel Measurement Diameter Measurements Depth (mm) (mm) Needle Sheath PICC angle Angle (deg) Angle (deg) (deg) Mean 8 4 157 162 161 10 SD 5 1 9 4 8 Table 3. Jugular line implant access measurements Vessel Access Device Angle Number of Vessel Measurement Diameter Measurements Depth (mm) (mm) Needle Sheath Catheter Angle (deg) Angle (deg) angle (deg) Mean 10 15 146 142 142 10 SD 2 3 11 12 8 Our Services At MED Institute, we have the tools and experience to help with your anatomic modeling needs. Contact us so that we can help you make products and therapies that will improve patient outcomes. If you have any questions or need any additional information, please contact: Justin Metcalf, Director of Engineering Services [email protected] 765.426.9728 References [1] Doby, T. Cerebral Angiography and Egas Moniz. American Journal of Roentgenology. 159: 364. August 1992. www.medinstitute.com INSTITUTE 765.463.1633 MED.
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