Equipment List

Abbreviated Implant Equipment List
Questions or problems contact me seth@mcworley.com or 717-917-8386
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Catheters for CS cannulation/CS access– unlike the device company catheter you only need one shape
1. Worley Standard. The kit includes a white 9 French I.D. 40cm long, hemostatic peel away sheath, a long pale blue plastic introducer, a deep blue braided introducer (referred to as the “braided core”), an 18 gauge needle, a long .035 inch wire and an introducer for the hemostatic hub. This is the sheath I use 95% of the time. (Worley Advanced Standard Curve; Order # WOR-CSG-B1-09 Merit Medical). If cephalic cut down consider the Worley Advanced Standard Curve Long (Order # WOR-CSG-BL1-09. Merit Medical).
2. Worley Jumbo for massive hearts. The “Jumbo Worley” is essentially the same as the “Standard Worley” but has a larger curve to reach from the RA to the CS and is also longer. The Jumbo Worley kit contains the same components as the “Standard Worley”. (Worley Advanced Jumbo Curve; Order # WOR-CSG-B2-09. Merit Medical).
3. Mach 1 MP2 6F 100cm no side holes (MP2) Order # 34356-39 Boston Scientific or 6 Fr. MB1 Z2 Guiding Catheter Medtronic Vascular Z26MB1 (is very similar shape to the Boston Mach 1 MP2) hand shaped to look like the braided core for difficult to find CS from the right or left. NOTE need guide not diagnostic catheter able to accommodate two .035 in. wires.
Vein Selectors: Inserted into the CS to locate the target vein with a puff of contract, cannulate the target vein and advance wires into the target vein. The vein selector may be used alone or telescoped inside a sub-selector e.g. The LVI renal. When telescoped inside the LVI sub-selector the wire stabilized vein selector serves as a rail over which to advance the delivery guide. A must have tool regardless of how you implant.
1. Worley Standard Vein Selector (5 Fr. x 75cm)
Merit Order # 57538CS-WOR Merit Medical
2. Worley Vert Vein Selector (5 Fr. x 75cm)
Merit Order # 57538CSV-WOR Merit Medical
3. Worley Hook Vein Selector (5 Fr. x 75cm)
Merit Order # 57538CSHK-WOR Merit Medical
Note The Worley Standard Vein Selector is sufficient for 90% of cases and is also included with Worley Advanced Telescopic LVI sub-selectors)

Sub-Selectors (aka “Inner Guide” Catheter ) i.e. catheters designed to be advanced into the target vein for direct delivery of the LV lead. Unlike the device company sub-selectors (CPS AIM or Select II) you only need one shape because vein selector is (telescoped within the inner) is used to locate, cannulate, deliver the wires and serve as a rail over which to advance the sub-selector (inner)
1. For 6 and 7 Fr. leads use the Worley Renal Shape lateral vein introducer kit that contains 1. The braided 9F OD/7F ID renal shape delivery guide, the Worley Standard Vein Selector and the slicing tool
a. Merit Medical = Worley Advanced Telescopic LVI System Renal (Order # WORLVI-75-5-62-07-RE Merit Medical).
2. For “5 Fr.” leads for 5 Fr. and smaller leads use the 5.5 Fr. ID Worley advanced Telescoping LVI.

Contrast Injection System:
1. Contrast Injection System Worley Advanced Kit 1 CAK 1(comes w/contrast bowl and labels) (order # K12-WORLEY1 Merit Medical) – OR
2. Worley Advanced Kit CAK 2 (without bowl and labels) (Order # K12-WORLEY2 Merit Medical)

Wires
Wires with a polymer tip/jacket (PT) and hydrophilic coating are essential for crossing subclavian obstructions and for LV lead placement. It is important to note that a polymer tip/jacket is NOT the same as hydrophilic. Essentially all wires are hydrophilic, while only some have a polymer jacket/tip. If the tip of the wire is not black it is not a polymer tip wire. These wires are available from multiple vendors with slightly different names. The polymer tip/jacket, level of support, length, and tip configuration are the key issue.

For crossing a subclavian occlusion and to Facilitate CS Cannulation – Polymer coated angled tip hydrophilic wires:
1. .035 in. x 180 cm angled tip polymer coated hydrophilic wire available from multiple vendors including Merit Medical Laureate (Order # LWSTDA35180 Merit Medical).
2. .018 in. x 180 cm angled tip polymer coated hydrophilic wire available from multiple vendors including Merit Medical Laureate (Order # LWSTDA18180 Merit Medical)
For advancing into the target vein for subsequent LV lead placement –Polymer jacket straight tip light & extra support
1. 0.014 in. Polymer Tip (PT) Straight wires for advancing into the target vein and through collaterals.
Light support (floppy) Wires. Light support straight polymer tip wires negotiate collaterals better than the wires with preformed tips and more support. You need both standard length (182-190 cm) and long (300 cm) light support wires. If the tip of the wire is not black it is not a polymer jacket/tip wire.
Extra Support Wires. Extra support polymer tip wires are useful to add as a second wire after the light support wire is in place to create a rail over which to advance the vein selector. You only need the extra support version in standard length (180-190cm). Below are examples of polymer tip/jacket wires I find useful. NOTE* both Abbott and Boston Scientific make a “Whisper wire”.
Avoid the Boston Scientific Acuity Whisper EDS, it is too stiff
a. ChoICE PT (Polymer Tip) Straight Tip Light Support (standard and long lengths) and ChoICE PT (Polymer Tip) Straight Tip Extra Support (standard length only) –or-
b. PT 2 Straight Light Support (standard and long lengths) and PT 2 Straight Tip Extra Support (standard length only) –or
c. HI-TORQUE WHISPER LS (light support) (standard and long lengths) and HI-TORQUE WHISPER ES (standard length) Abbott Vascular. Caution: avoid the Boston Scientific Acuity WHISPER EDS. –or-
d. Fielder XT-R Asahi (tip tapers to .010 in.) Lighter support than the Fielder XT and Fielder XT-A (standard and long lengths)
2. .018 in. Polymer Tip Hydrophilic wires to create a more supportive rail with the vein selector for LV Lead placement. This wire is placed through the vein selector after the light support wire. Specifically, the 200 cm short taper V-18 Control Wire Guidewire wICE Coating Boston Scientific. Note* Medtronic leads (only) will advance over a .018 inch wire (they have a .018 in lumen). Availability of .018 inch wire can make the difference between success and failure (Catalog # 46-852).

J Tip Extra Stiff Support Wires: NOTE: Not all “Amplatz Extra Stiff ” wires are created equal! For example, both the Boston Scientific and Cook are labeled “Amplatz Extra Stiff” however the support is very different. With “Extra Support” wires the total length, the coating, the tip (J tip not straight), the length of the floppy section after the J tip, and stiffness are the key issues. In my experience the Cook Amplatz Extra Stiff Wire Guide provides the best option for providing stability in the CS not the Boston Scientific with essentially the same name; Details: .035 in. diameter, 180 cm. total length, PTFE-Coated Stainless Steel, 3 mm curve J tip, 3 cm. floppy tip length, and 7 cm. taper length (THSCF-35-180-3-AES, Order # G03565). Having the correct wire (Cook) will make the difference between success and failure.

Equipment for Venous Access and Subclavian Venoplasty in Patients with Existing Leads and Venous Obstruction
Initial Venous Access
5 Fr. Micro-puncture Kit with radiopaque tip and stiffened dilator
Merit Medical. The 21guage needle and angled tip .018 inch Nitinol wire may make it easier access the vein initially. The stiffened dilator (indicated by the S in the order #) provides additional support during placement through scar tissue and/or difficult anatomy when compared to a standard micro-puncture kit. The stiffened dilator is also more radiopaque so you can be certain the tip is in the vein. The final point is the length of the catheter (15 cm) so the tip may often be beyond the stenosis. (Order # S-MAK501N15BT) (Catheter = 5F-15 cm, wire = 0.018” x 60 cm Nitinol with platinum tip, needle = 21G x 7 cm.

Equipment for crossing a subclavian obstruction once the catheter from the micro-puncture kit is in the vein.

Wires with a polymer tip (PT) and hydrophilic coating for crossing subclavian obstructions and LV lead placement (AKA glide wire or Terumo). These wires are available from multiple vendors with slightly different names. The polymer tip and hydrophilic coating, length, diameter and tip configuration are the key issue.
1. Polymer tip hydrophilic wires for Crossing Subclavian Occlusions (need two diameters).
a. .035 in. x 180 cm angled tip hydrophilic wire available from multiple vendors including Merit Medical Laureate wire angled tip .035/180cm (Order # LWSTDA35180 Merit Medical).
b. .018 in. x 180 cm angled polymer tip hydrophilic wire available from multiple vendors Including Merit Medical (Order # LWSTDA18180 Merit Medical).
Steering handle (torque device) for hydrophilic wires (caution one size does not work for all size wires multiple vendors including Merit Medical)
1. Torque device for .014inch to .018 inch wires
2. Torque Device for .025 inch to .038 inch wires

Braided hydrophilic catheter with a 5 mm. angled tip to help direct a wire across a total subclavian occlusion & to upgrade wire support.
Catheters for crossing total occlusions. I have the most experience with the 5 Fr. version. Similar catheters without metal braid (Terumo) do not have adequate torque control. To my surprise I also found slight variation in the angle and length of the tip are critical to function.
Catheters for wire exchange. The braided hydrophilic catheters (above) are also used to exchange a .035 in. polymer tip wire for a .035 in. extra stiff support wire. Hydrophilic catheters without metal braid (e.g. Terumo) don’t advance as well through a stenosis as a catheter with metal braid.
1. 5 Fr. Impress KA 2 Hydrophilic Angiographic Catheter 5Fr. 65 cm (Order # 56538KA2-H Merit Medical).
2. 4 Fr. Impress KA 2 Hydrophilic Angiographic Catheter 4Fr. 65 cm (Order # 46538KA2-H Merit Medical) used if the 5 Fr. KA 2 will not track over the wire through the occlusion and also for advancing a wire into the MCV for the the snare technique.

Balloons for Coronary Venoplasty; non-compliant (RBP 18-20 ATM) & rapid exchange available from multiple vendors e.g. NC Sprinter from Medtronic.
1. 2.5 mm x15 mm
2. 3.0 mm x 15 mm
3. 3.5 mm x 15 mm

Balloons for Subclavian Venoplasty –Ultra non-compliant and over the wire. Because a .035 in. hydrophilic wire is usually used to cross the subclavian obstruction you want a balloon with a .035 in. lumen.
1. To add one lead use a 6 mm diameter x 4 cm length x 75cm. Example CONQUEST (Kevlar) Order # CQ-7564 Bard Peripheral Vascular Ultra-noncompliant: wire lumen 0.035 in, over the wire, rated burst pressure 30 atm.
2. To add two leads or if there is elastic recoil use a 9 mm x 4 cm X 75cm balloon Bard Peripheral Vascular Ultra-noncompliant: wire lumen 0.035 in, over the wire, rated burst pressure 26 atm. Order # CQ-7594 Bard Peripheral Vascular.
3. For cases where the 6-9 mm diameter balloon will not advance across the obstruction use the 4 Fr. braided hydrophilic catheter (above) to exchange the .035 inch wire for a .014 in extra support wire and pre-dilate with a coronary balloon. Once pre-dilated exchange the .014 in wire for the .035 in j tip extra support wire and finish dilating with the 6-9 mm balloon.

Equipment for Implementing the Snare Technique

Micro Snares for CS LV lead placement:
1. 10 mm/4 F Merit One Snare ONE 1000 (snare = 10 mm loop, 120 cm length; catheter = 4 Fr. 100 cm length inside diameter 1.02 mm). This 10 mm snare fits into the 9 French internal diameter CSG Worley beside the vein selector. (order # ONE100 Merit Medical)
Catheter for directing a wire into the exit vein for subsequent snare placement.
1. 4 Fr. Impress KA 2 Hydrophilic Angiographic Catheter 4Fr. 65 cm (Order # 46538KA2-H Merit Medical) used to direct a .035 in 180cm angled polymer tip wire (Laureate Order # LWSTDA35180 Merit Medical) into the exit vein. The wire is then used to then place the snare catheter directly into the exit vein. The 4 Fr. Vert fits beside the “Vein Selector”.
Wires to consider for implementing the snare technique.
1. The straight polymer tip hydrophilic light support .014 in angioplasty wires listed above works well for crossing the collaterals in most cases.
2. The antidromic snare technique requires a 300 cm straight polymer hydrophilic wire.
For crossing occlusions and negotiating collaterals if the .014 inch hydrophilic angioplasty wires do not work consider the Confianza Pro 180 ASAHI Intec CO LTD – hydrophilic and the tip tapers from .014 inch to .009 inch (Abbott Vascular)
Micro catheter to prevent cheese cutter effect for the antidromic snare technique.
1. Merit SureCross Support Catheter (length 90 cm, wire diameter .014 in, tip diameter .020 in {1.52 Fr.}) Catalog Number SC1490.

Equipment for Right Side Access
Approach # 1 WOR-CSG-BR1-09

Approach #2
1. AL2 or 3 guide NOT diagnostic catheter (guide is large enough for two wires)
2. Mach 1 MP2 6F 100cm no side holes (MP2) Order # 34356-39 Boston Scientific.
3. 6 Fr. MB1 Z2 Guiding Catheter Medtronic Vascular Z26MB1 (is very similar shape to the Boston Mach 1 MP2)

Approach #3
1. Attain Command MPR.
2. SafeSheath® Ultra Worley Right-sided Access Introducer (Short Worley Right). Pressure Products

Adapter to eliminate phrenic pacing by placing a second lead in the AIV or by inserting two leads in the same vein. (order # Lead Adapter Kit 5866-38m Medtronic Minneapolis MI converts two unipolar leads into a bipolar lead).

Equipment Summery
1. Worley Advanced Standard Curve; Order # WOR-CSG-B1-09 Merit Medical
2. Worley Advanced Jumbo Curve; Order # WOR-CSG-B2-09. Merit Medical.
3. Mach 1 MP2 6F 100cm no side holes (MP2) Order # 34356-39 Boston Scientific or 6 Fr. MB1 Z2 Guiding Catheter Medtronic Vascular Z26MB1 (is very similar shape to the Boston Mach 1 MP2) hand shaped to look like the braided core for difficult to find CS from the right or left. NOTE guide not diagnostic catheter able to accommodate two .035 in. wires.
4. Worley Standard Vein Selector (5 Fr. x 75cm) Merit Order # 57538CS-WOR Merit Medical.
5. Worley Vert Vein Selector (5 Fr. x 75cm) Merit Order # 57538CSV-WOR Merit Medical
6. Worley Hook Vein Selector (5 Fr. x 75cm) Merit Order # 57538CSHK-WOR Merit Medical
7. Contrast Injection System Worley Advanced Kit 1 CAK 1(comes w/contrast bowl and labels) (order # K12-WORLEY1 Merit Medical)
8. 7.0 ID Worley Advanced Telescopic LVI System Renal (Order # WORLVI-75-5-62-07-RE Merit Medical).
9. 5.5 Fr. ID Worley advanced Telescoping LVI System Renal will be available May 1st 2016 for 5 Fr. and smaller leads (MDT quad too large)
10. 5 Fr. Micro-puncture Kit with .018 Nitinol wire and stiffened radiopaque dilator Merit Medical. Order # S-MAK501N15BT
11. 5 Fr. Impress KA 2 Hydrophilic Angiographic Catheter 5Fr. 65 cm (Order # 56538KA2-H Merit Medical) to assist crossing difficult subclavian obstruction
12. 4 Fr. Impress Straight Hydrophilic Angiographic Catheter 4Fr., 65 cm. (Order # 46538STS-H Merit Medical) to exchange polymer tip hydrophilic wire (AKA glide wire or Terumo) for an extra support wire.
13. 4 Fr. Impress KA 2 Hydrophilic Angiographic Catheter 4Fr. 65 cm (Order # 46538KA2-H Merit Medical)
14. .014 in. ChoICE PT (Polymer Tip) Straight tip Light Support (order # 1211-01 Boston Scientific).
15. .014 in. ChoICE PT (Polymer Tip) Straight (not angled) Tip Extra Support (order # 12161-01 Boston Scientific).
16. .014 in. ChoICE PT (Polymer Tip) Straight (not angled) tip Light Support 300 cm Boston Scientific
17. .018 V-18 Control Wire Guidewire wICE Coating Polymer Tip Hydrophilic (.018 in 200 cm short taper) Boston Scientific (Catalog # 46-852).
18. Amplatz Extra Stiff Wire Guide, .035in, 180cm, 3mm tip curve Cook (THSCF-35-180-3-AES) (another ref # on the package is G03565). (Do not substitute)
19. Angled (not straight) polymer tip hydrophilic wire.035 in. x 180 cm Laureate wire (Order # LWSTDA35180 Merit Medical) (AKA Glide wire or Terumo)
20. Angled (not straight) polymer tip hydrophilic wire .018 in. x 180 cm (Laureate Wire Order # LWSTDA18180 Merit Medical). (AKA Glide wire or Terumo)
21. Snare (Micro) 10 mm loop /4 F snare catheter Merit One Snare ONE 1000 (snare = 10 mm loop, 120 cm length; catheter = 4 Fr. 100 cm length inside diameter 1.02 mm). This 10 mm snare fits into the 9 French internal diameter CSG Worley beside the vein selector. (order # ONE100 Merit Medical)
22. Micro catheter for the antidromic technique Merit SureCross Support Catheter (length 90 cm, wire diameter .014 in, tip diameter .020 in {1.52 Fr.}) Catalog Number SC1490.
23. Subclavian venoplasty balloon 6 mm diameter x 4 cm length x 75cm. CONQUEST Order # CQ-7564 Bard Peripheral Vascular rated burst pressure 30 atm.
24. Subclavian venoplasty 9 mm x 4 cm X 75cm balloon Order # CQ-7594 Bard Peripheral Vascular rated burst pressure 26 atm.

Ordering Information
1. Abbott Vascular, Santa Clara, CA 95054 USA # 800-227-9902
2. Bard Peripheral Vascular Tempe AZ USA # 800-321-4254
3. Biosense Webster, Diamond Bar CA # 909-839-8500
4. Boston Scientific Natick MA 01760 USA # 800—227-3422
5. Cook Incorporated Bloomington IN 47404 USA # 800-457-4500
6. Cook Vascular, Vandergrift, PA USA
7. Cordis Corporation Bridgewater, NJ USA # 800 997 1122
8. Ethicon, Inc. Somerville, NL USA 908-218-0707
9. Mallinckrodt Inc, St Louis, MO USA # 888-744-1414
10. Medtronic, Inc Minneapolis, MN 55432 USA 763-574-4000
11. Merit Medical Systems, Inc South Jordan, Utah USA Call # 800-626-3748
12. Oscor 3816 DeSoto Boulevard, Palm Harbor, FL USA # 800-726-7267