Elective or emergent interventional radiology through introducer sheath inserted during emergent vascular surgery for...

During performance of embolectomy or thrombectomy one often encounters arterial stenoses. These may be treated by adjunctive intraoperative angioplasty during the operation or delayed percutaneous angioplasty (PTA) may be performed in the interventional radiology department. Delayed PTA may have to wait until the wound has healed, and during this time there is a risk of re-occlusion. It may often be desirable to perform the radiologic intervention at a later time than the thrombo-embolectomy for logistic reasons. The vascular surgeon and interventional radiologist may perform best when working in the environment that they are accustomed to. Also, measurement of vascular diameters, and selection of proper balloon and stent sizes can usually be performed most accurately with the equipment that is available in the X-ray department. We treated selected patients who underwent thromboembolectomy or thrombendarterectomy in the groin for critical ischemia, and who also had clinically important proximal or distal stenoses, in the following way: an arterial sheath was inserted through the wound and the patients were transferred to the interventional radiology laboratory where they underwent PTA. A continuous over and over suture with 3 bites of a 6-0 polypropylene suture in the arteriotomy for the sheath appeared to be the best way to secure hemostasis. The wound was closed around this suture and the arterial sheath. After removal of the sheath slight traction was applied to the polypropylene suture and maintained for 1-2 days by application of a hemostat at skin level. The technique is illustrated with a case report.