Q: Will the LGF device work with any guidewire? A: No, only with the LGF guidewire that is fitted with a distal stopper. The system comes delivered with two guidewires, one 180cm and one 280cm. Q: How flexible is the LGF guidewire? A: The LGF guidewire can be compared to a conventional Rosen Guidewire, except slightly softer. The guidewire also has a removable core, achieving a wire with further flexibility if removed. Q: How much anchoring force does the LGF withstand? A: The recommended maximum anchoring force is 3N. Q: What happens if too much tension is applied? A: The longitudinal compression is limited by a fixed structure to prevent over-expansion and damage to the artery. Too much tension will cause the fixator to invert and lose its anchoring quality. Q: Can you use any readily available sheath for delivery and retrieval of the LGF? A: The IFU recommends using the 7F pinnacle destination from Terumo. Other sheaths, such as the Flexor Ansel from COOK may also work, however these have a harder valve membrane, which demonstrates more resistance when inserting the fixator. Q: How is of the catheter rotated during placement and retrieval? A: The LGF system comes with a torque device that fits on the retrieval catheter to facilitate easy rotation. Q: Is the LGF CE & FDA approved? A: The device is CE marked approved as a class IIa medical device. Facilitated method for f/b-EVAR
Q: During a pararenal case, how can you prevent guidewire entanglement? A: Guidewire entanglement is managed before stentgraft insertion by a swift guidewire “sorting procedure” using a multi lumen sheath. More about the sorting procedure can be found here.
Q: Do I have to use the LGF guidewire when placing the bridging graft and is it stiff enough? A: Once the target artery has been catheterised with the sheath, the LGF can be retrieved and the guidewire replaced if needed. However, the guidewire rigidity is essential when accessing the branch, where the LGF offers tension to achieve traction. Once you have sheath access, placing the bridging graft is rarely an issue. Q: What is the risk that the LGF wires will get stuck on the top stent during stentgraft deployment? A: Yes, as with any pre-lined approach. This is managed by using top cap control and by continuously retracting the LGF guidewires during deployment in order to always stay below the expanding stentgraft. The LGF guidewire is designed with a flexible Nitinol core to allow sharp angulations.
