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Induction Of Labor
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Compared to a single-balloon Foley catheter, there was no difference in time to delivery, CD, or intrapartum fever in two meta-analyses of four trials [67, 73]. Additionally, there was a higher rate of patient discomfort with the double-balloon catheter compared to single-balloon Foley [73]. Time from induction to delivery was longer in the double-balloon group in one trial [68]. There is also a significant cost difference between the catheters: single-balloon Foley catheters may cost up to $12–$14 (US) for large balloon catheters (75 mL), but are cheaper when 30 mL balloons are used. The double-balloon catheter costs labor and delivery units over $200 (US) per unit. There is currently insufficient evidence to support the use of double-balloon catheters over single-balloon catheters for the induction of labor. Until further information is available, a Foley catheter should be used over a double-balloon catheter for both efficacy and economic concerns.
Miscellaneous
Published in Kelvin Yan, Surgical and Anaesthetic Instruments for OSCEs, 2021
Further development of balloon catheters now also offers a variety of uses. Larger occlusion catheters (i.e. 8 F with a diameter of up to 45 mm) may be used for the occlusion control of large vessel haemorrhage including the aorta. It has also been used in as a bronchial blocker for one lung ventilation in anaesthetics to facilitate cardiothoracic/upper GI surgery. Further, it has been described in the retrieval of nasal foreign bodies.
Angioplasty Balloons and Technique
Published in Vikram S. Kashyap, Matthew Janko, Justin A. Smith, Endovascular Tools & Techniques Made Easy, 2020
The angioplasty balloon has multiple structural parameters. Balloons come in different sizes that correspond to the balloon diameter, balloon length, and length of the balloon catheter. Diameters start as small as 1.0 mm and can go beyond 40 mm (specialty aortic balloons). Smaller balloons typically increase by 0.5-mm increments until they reach a diameter of 5 mm, then increase by 1 mm up until 10 mm, and then increase by 2 mm up to about 24 mm. Balloon length describes the length of the balloon segment and range from about 10 mm to greater than 300 mm. The catheter itself that delivers the balloon can be as short as 40 cm or longer than 170 cm. Selection of the catheter length depends on the site of the lesion to be treated and the access point. If access is in the groin and the lesion is in the ipsilateral iliac artery, then a short catheter will reach. If the target, however, is distal on the contralateral limb, then a long catheter length will be needed.
Endoscopic Coronary Catheter Dacryoplasty for Failed DCR in Wegener’s Granulomatosis
Published in Ocular Immunology and Inflammation, 2023
Rafal Nowak, Mohammad Javed Ali
Multiple times failed dacryocystorhinostomy (DCR) is not very common and presents several surgical challenges.1–3 An adult female, 73-years of age, known case of granulomatosis with polyangiitis (Wegener’s granulomatosis) on immunosuppressive therapy, presented with left-sided gross epiphora and recurrent attacks of acute dacryocystitis. In the past, she unsuccessfully underwent laser DCR and then an external DCR. The right side was doing well after an external DCR. Endoscopy evaluation showed widespread destruction in the left nasal cavity with a tiny ostium, surrounded by scared tissue, partially patent with irrigation (Figure 1, circle area, panel A). A standard balloon dacryoplasty was performed with a 4 mm coronary balloon catheter (Boston Scientific, USA) (panel B). The peripheral scar tissues of the neo-ostium were debrided, followed by a Mitomycin-C application. The immediate postoperative period showed a large internal common opening (arrow, panel C). At 3-month follow-up, the ostium was large, anatomically, and functionally patent (arrow, Panel D) with a FICI grading of +5.4 The patient was asymptomatic at 6 months of follow-up and was continuing the immunosuppressive therapy. Lacrimal drainage obstruction in a setting of Wegener’s granulomatosis is challenging.5,6 The current case demonstrates that balloon-assisted revision of a DCR ostium is a feasible alternative in cases of failed DCR in Wegener’s granulomatosis. The use of a coronary balloon catheter is a viable and economically feasible alternative in such cases.
A prospective, multi-center, randomised controlled trial for evaluation of the effectiveness of the Blimp scoring balloon in lesions not crossable with a conventional balloon or microcatheter: the BLIMP study
Published in Acta Cardiologica, 2023
J. Dens, W. Holvoet, K. McCutcheon, C. Ungureanu, P. Coussement, S. Haine, Q. De Hemptinne, J. Sonck, W. Eertmans, J. Bennett
With an inflated balloon diameter of 0.6 mm, the Blimp is the smallest balloon catheter in the world at this time. With a rated burst pressure of 30 ATM, the Blimp is the highest rated burst pressure balloon compared to balloons with diameters of 1.5 mm or smaller. With the rapid exchange (Rx) port only extending over the distal tip section, the guidewire creates a scoring element over the balloon. Such scoring elements create approximately four times the amount of Maximum Principle Stress on the vessel compared to the same size regular balloon catheter [5]. At the rated burst, Blimp can create a principle stress equivalent to 160 ATM. The very short Rx section whereby the guidewire forms a scoring element over the balloon furthermore enables wedging if the balloon does not cross directly. The balloon body has, as with all balloon catheters, a larger profile. Therefore, the balloon body is less likely to cross the lesion than the distal tip. If the Blimp balloon is inflated with only a fraction of the distal tip of the balloon wedged inside the lesion/proximal cap, it is possible that the guidewire/scoring element at high inflation pressure will start to modify the lesion/cap resulting in subsequent full lesion entry of the body of the Blimp balloon.
Ten-year follow-up after endocardial point-by-point cryoablation for paroxysmal atrial fibrillation
Published in Acta Cardiologica, 2021
Mindy Vroomen, Frank van Rosmalen, Jessie Schröder, Suzanne Philippens, Tammo Delhaas, Harry J. Crijns, Laurent Pison
The difference in outcome between point-by-point cryoPVI compared to first and second-generation cryoballoons and RF catheters, is most likely caused by the fact that in this study no continuous lesions were performed, no inter-lesion distance was respected and PVs were targeted based on PV potentials. The difference in isolation level might also have played a role in the high recurrence rate. In the past years, it has become clear that results of PVI improve when a wide antral ablation is performed compared to ostial ablation [2]. In ostial ablation AF triggers located at the antrum of the PV might be missed, therefore, circumferential lesions should be made to decrease recurrence rates. The newer balloon catheters as well as the easier to use RF catheters in combination with 3D anatomical mapping seem to be more suitable than the technique used in this study for the creation of continuous lesions. Other advantages of the balloon catheters over the point-by-point catheters is the ability to create antral lesions more easily, and the confirmation of adequate balloon tissue contact by checking vein occlusion with contrast.