Video 5.1 Note the low angle of insertion and the bounce of the needle as it advances slowly toward the artery using gentle palpation of the artery with the tips of the first two fingers of the left hand. The needle should be bouncing up and down and not side to side.
Video 5.3 Note that the loop is now straightened by the guidewire and is now safe to traverse with a catheter. All subsequent catheter exchanges should be made over an exchange-length guidewire.
Video 5.5 Note tortuosity of the subclavian artery with the tip of the angled Glidewire appearing to be in the ascending aorta.
Video 5.7 With the tip of the diagnostic catheter at the aortic knob and the guidewire in the descending aorta, the patient is asked to take a deep breath, and the catheter is torqued toward the ascending aorta as the guidewire is retracted and then readvanced when the catheter is pointing toward the ascending aorta.
Video 5.9 The left main coronary artery (LMCA) is engaged with a 110-cm-long multipurpose catheter with the guidewire in place in order to overcome the extreme tortuosity. The guidewire is carefully withdrawn once the LMCA is approached in the left coronary cusp with the adjustment of advancing or withdrawing the catheter until the LMCA is selectively engaged.
Video 5.11 The tortuosity is overcome by the angled Glidewire that is now in the ascending aorta.
Video 7.2 Cannulation of the left coronary with a universal catheter using the superior approach with a 5-Fr RBLBT (Cordis, Bridgewater, NJ). The curve is opened from above using a J-wire, and the catheter is advanced into the left coronary.
Video 16.1 Run 1: Excessive tortuosity of upper extremity arteries below the olecranon fossa (videoclip label: Nadel Run 1).
Video 16.1 Run 3: Tortuous radial artery with forced straightening, perforated while attempting to advance diagnostic catheter. Perforation managed with external pressure (videoclip label: AJ radial art perf).
Video 5.2 The loop in the brachial artery above the elbow is overcome with an angled Glidewire gradually advanced through the loop. It is advisable to overcome the loop with a soft-tipped angled or J-tipped guidewire followed by a catheter in order not to dissect the artery or cause spasm.
Video 5.4 Note the severe tortuosity of the radial artery with the angled-tipped Glidewire entering a small branch at the top of the curve (recurrent radial artery). You can see how advancing a catheter into this vessel at the very least would cause severe spasm and at worst could cause perforation.
Video 5.6 Note how the guidewire and the following Judkins Left 3.5 diagnostic catheter have straightened out the tortuosity, but the tip of the guidewire is now in the descending aorta.
Video 5.8 Note extreme tortuosity of subclavian artery. This may be negotiated with a J-tipped guidewire advancing a catheter over the curves and ultimately into the ascending aorta.
Video 5.10 Note the severe tortuosity of the subclavian artery that is negotiated with an angled Glidewire. A J-tipped Glidewire may be equally effective in negotiating the tortuosity. The advantage of the J-tipped Glidewire is that it may be helpful in avoiding side branches because it usually selects the large main branch and stays out of smaller side branches that can be perforated by the angled Glidewire.
Video 7.1 Left coronary cannulation technique using universal catheter. A 5-Fr RBLBT (Cordis, Bridgewater, NJ) is positioned in the left coronary cusp and advanced to engage the left coronary.
Video 7.3 Right coronary cannulation technique using universal catheter. The right coronary cusp is usually inferior to the left coronary cusp. Thus, engagement of the right coronary involves counterclockwise rotation and forward advancement into the right coronary artery.
Video 16.1 Run 2: Excessive tortuosity of upper extremity arteries above the olecranon fossa. Note pseudostenosis of forearm arteries as a result of forced straightening of tortuous vessels. Radial approach abandoned to avoid injury (videoclip label: Nadel Run 2).