Kanda Daisuke, Horizoe Yoshihisa, Tabata Hiroyuki, Uchiyama Youta, Ohishi Mitsuru
Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
JACC Case Rep. 2025 Aug 6;30(22):104570. doi: 10.1016/j.jaccas.2025.104570.
Transfemoral venous access is the standard for MitraClip procedures, but anatomic variations can hinder device delivery.
An 88-year-old man with severe mitral regurgitation underwent MitraClip therapy via the right femoral vein. During the procedure, compression by a calcified right iliac artery caused severe tortuosity of the iliac vein, preventing the advancement of the steerable guide catheter. A buddy wire was introduced through a left femoral crossover approach using a Radifocus guidewire into the right iliac vein, allowing successful catheter advancement and device deployment.
This case highlights the importance of adaptive strategies to overcome anatomic challenges. The buddy wire technique allows for more controlled catheter manipulation and may have reduced the risk of venous injury.
TAKE-HOME MESSAGE: The crossover buddy wire technique may be a useful bailout strategy with only minimal additional equipment to facilitate steerable guide catheter delivery in cases of venous compression.
经股静脉入路是二尖瓣夹合术的标准入路，但解剖变异可能会阻碍器械输送。
一名88岁重度二尖瓣反流男性患者经右股静脉接受二尖瓣夹合治疗。术中，钙化的右髂动脉压迫导致髂静脉严重扭曲，可弯曲导引导管无法推进。通过使用Radifocus导丝经左股交叉入路将导丝引入右髂静脉，使导管得以成功推进并完成器械植入。
本病例凸显了采用适应性策略克服解剖学挑战的重要性。导丝技术可使导管操作更可控，并可能降低静脉损伤风险。
交叉导丝技术可能是一种有用的补救策略，只需极少额外设备，即可在静脉受压情况下便于可弯曲导引导管的输送。
