Ask Dr. Z

Does using a "micropuncture" needle/sheath mean that a procedure was done percutaneously, or can it sometimes mean open? Examples: 1) Dissected out the fistula and then accessed the aneurysm with a micropuncture 6 French sheath. 2) A right upper arm incision was made distal to the axilla. The brachial artery and vein were identified. The brachial artery was circumferentially dissected and encircled with Vesseloops. Needle access to the brachial vein was obtained with a micropuncture needle, allowing placement of a micropuncture sheath. Right upper extremity and central venograms performed, showing occlusion of a previously placed right innominate vein stent. A 6 French sheath was inserted. A guidewire was advanced across the right subclavian and innominate vein occlusion. Balloon angioplasty of the stent performed. The 6 French sheath was exchanged for 12 French peel-away sheath. Gore hybrid stent graft was inserted using the introducer sheath. It was placed into the right brachial vein and deployed after removing the peel-away sheath. The graft was tunneled in a loop fashion.