Reduce Early Graft Failure Following CABG Surgery Improve patient outcomes Verify graft patency
Cardiac Surgery Reduce Early Graft Failure Following CABG Surgery • Improve patient outcomes • Verify graft patency • Reduce bring-backs Cardiac Surgery Coronary Flowprobes take the guesswork out of knowing bypass flow Transonic® Cardiovascular Flowprobes work with the Transonic® Optima Flowmeter to measure volume flow in vessels or grafts from 1.3 - 36 mm diameter. The non-constrictive perivascular Flowprobes use transittime ultrasound technology to measure volume blood flow directly, quickly and easily, even in the low-flow range. The surgeon now has a quantitative tool with which to objectively assess the quality of the anastomosis. Unseen blood flow obstructions can be detected intraoperatively and repaired before closing the patient. This ability to correct otherwise undetectable flow restrictions gives the surgeon with a unique opportunity to improve patient outcomes. European Revascularization Guidelines “Graft flow measurement, related to graft type, vessel size, degree of stenosis, quality of anastomosis, and outflow area, is useful at the end of surgery. Flow <20 mL/min and pulsatility index >5 predict technically inadequate grafts, mandating graft revision before leaving the operating theatre.”1 1 The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) “Guidelines on Myocardial Revascularization,” Eur J CardiothoracSurg 2010; 38, S1 S52 www.transonic.com “…TTFM predicts graft failure within six months after CABG.” Jokinen et al,“Clinical value of intra-operative transit-time flow measurement for coronary artery bypass grafting: a prospective angiography-controlled study”, Eur J Cardiothorac Surg 2011;39(6):918-23. “TTFM is a reliable method to verify intraoperative graft patency.” Di Giammarco et al, “Can transit-time flow measurement improve graft patency and clinical outcome in patients undergoing coronary artery bypass grafting?” Interact Cardiovasc Thorac Surg 2010; 11(5): 635-40. “Routinely, the use of TTFD significantly reduced the incidence of post operative VFib, post-operative CK/CK-MB fraction and angiographically detected bypass malfunction.” Bauer SF et al, “Intraoperative bypass flow measurement reduces the incidence of postoperative ventricular fibrillation and myocardial markers after coronary revascularisation,” Thorac Cardiovasc Surg 2005; 53(4): 217-22. “The intraoperative use of flow measurements provide invaluable information in a timely, accurate, cost-effective manner allowing for the surgical correction of a surgical problem. This has signficantly reduced the complication related to early technically induced graft failure.” Mindich B, MD TRANSIT-TIME ULTRASOUND TECHNOLOGY MEASURES VOLUME FLOW, NOT VELOCITY Two transducers pass ultrasonic signals, alternately intersecting the vessel in upstream and downstream directions. The difference between the two transit times yields a measure of volume flow. Transonic Systems Inc. is a global manufacturer of innovative biomedical measurement equipment. Founded in 1983, Transonic sells “gold standard” transit-time ultrasound flowmeters and monitors for surgical, hemodialysis, pediatric critical care, perfusion, interventional radiology and research applications. In addition, Transonic provides pressure and pressure volume systems, laser Doppler flowmeters and telemetry systems. AMERICAS EUROPE ASIA/PACIFIC JAPAN Transonic Systems Inc. 34 Dutch Mill Rd Ithaca, NY 14850 U.S.A. Tel: +1 607-257-5300 Fax: +1 607-257-7256 [email protected] Transonic Europe B.V. Business Park Stein 205 6181 MB Elsloo The Netherlands Tel: +31 43-407-7200 Fax: +31 43-407-7201 [email protected] Transonic Asia Inc. 6F-3 No 5 Hangsiang Rd Dayuan, Taoyuan County 33747 Taiwan, R.O.C. Tel: +886 3399-5806 Fax: +886 3399-5805 [email protected] Transonic Japan Inc. KS Bldg 201, 735-4 Kita-Akitsu Tokorozawa Saitama 359-0038 Japan Tel: +81 04-2946-8541 Fax: +81 04-2946-8542 [email protected] CABG Cover sheet (CV-200-fly) Rev. A 6-13 Cardiac Surgery Cardiac Surgery Flowprobes Transonic® Cardiac Surgery Flowprobes work with HT300-Series-FT Flowmeters to measure volume flow in blood vessels or grafts from 0.5 to 36.0 mm in diameter. Measurements offer the surgeon an opportunity to correct otherwise undetectable flow restrictions and guide surgical decisions to ensure the best surgical outcome for the patient. Fig. 1: Pictured, from left to right, are 1.5 mm, 2 mm, 3 mm and 4 mm coronary Flowprobes showing their blue Probe bodies, J-style reflectors and ultrasonic sensing windows. Fig. 3: Coronary Flowprobe Series: from bottom to top: 1.5 mm, 2 mm, 3 mm and 4 mm diameter. The vessel should fill between 60% and 100% of the probe sensing window. flexible neck probe body elongated handle Fig. 2: COnfidence Flowprobes® provide highly accurate measurements in vessels with fluctuating flows such as the ascending aorta. The Probes may be left in place for extended measurements and then easily removed via a ring attached to the pliable liner that cushions and protects the vessel. reflector Fig. 4: The Coronary Flowprobe’s elongated handle allows positioning of the Probe around coronary artery bypass grafts that reach around the back of the heart. As shown above, the Flowprobe’s flexible neck can be bent so that the Flowprobe can easily encircle a coronary graft or vessel. FMC-SERIES PERIVACULAR CORONARY BYPASS FLOWPROBES PROBE SIZE CATALOG # VESSEL OUTER DIAMETER OD (mm) 1.5 mm HQD 1.5FMC 1.3 - 2.3 2.0 mm HQD 2FMC 1.8 - 3.0 3.0 mm HQD 3FMC 2.4 - 4.0 4.0 mm HQD 4FMC 3.2 - 5.3 CardiacFlowmetersFlowprobes (CV-201-ds) Rev A 6-13 Cardiac Surgery Cardiac Surgery Flowmeters Transonic’s new Optima Flowmeter takes transit-time ultrasound flow measurement resolution to the highest level. The Optima’s unprecedented resolution accompanies lower offsets, and doubles the accuracy for low flows. The Optima Flowmeter enables use of our full line of Cardiovascular Flowprobes for vessels from 0.5 mm to 36 mm in diameter. The Flowprobe’s flexible neck permits optimal probe positioning and easy measurement. • Provides unsurpassed accuracy and resolution • Ensures vessel and graft patency • Immediate, quantitative flow measurements HT353 Single-channel Optima Flowmeter The AureFlo system continuously measures, displays, records and documents absolute volume flow and other derived parameters. Shown here with the new HT363 dual-channel Optima Flowmeter, it can be used with Transonic’s new Microsurgical Flowprobes. ® HT364 Dual-channel Optima Flowmeter permits simultaneous measurements with two Flowprobes. Transonic Systems Inc. is a global manufacturer of innovative biomedical measurement equipment. Founded in 1983, Transonic sells “gold standard” transit-time ultrasound flowmeters and monitors for surgical, hemodialysis, pediatric critical care, perfusion, interventional radiology and research applications. In addition, Transonic provides pressure and pressure volume systems, laser Doppler flowmeters and telemetry systems. www.transonic.com AMERICAS EUROPE ASIA/PACIFIC JAPAN Transonic Systems Inc. 34 Dutch Mill Rd Ithaca, NY 14850 U.S.A. Tel: +1 607-257-5300 Fax: +1 607-257-7256 [email protected] Transonic Europe B.V. Punterweg 31 6222 NW Maastricht The Netherlands Tel: +31 43-407-7200 Fax: +31 43-407-7201 [email protected] Transonic Asia Inc. 6F-3 No 5 Hangsiang Rd Dayuan, Taoyuan County 33747 Taiwan, R.O.C. Tel: +886 3399-5806 Fax: +886 3399-5805 [email protected] Transonic Japan Inc. KS Bldg 201, 735-4 Kita-Akitsu Tokorozawa Saitama 359-0038 Japan Tel: +81 04-2946-8541 Fax: +81 04-2946-8542 [email protected] CABG Surgery CABG Medical Protocol Intraoperative Graft Patency Assessment during CABG Surgery Measuring Graft Flow Diastolic-Dominant Pattern cont. Accurate measurements are technique dependent. • Select a Flowprobe sized so that the graft will fill at least 75% of the lumen of the Probe without compressing the graft. • Fill Probe window with ultrasound gel. • Position Probe on graft (not over metal clips or fascia). • Occlude native coronary artery and measure graft flow to establish maximum flow for the graft. • When flow reading is stable (10-15 seconds), press PRINT, take snapshot or record on AureFlo®. Does Mean Flow Confirm Graft Patency? • • Acceptable Mean Flow > 30 mL/min Medium Range Mean Flows (5 - 30mL/min) Does flow exhibit the expected pattern? Evaluate other factors that may lower flow such as vasospasm of arterial grafts; small target vessel or small patient; small graft capacity, poor runoff, or low mean arterial pressure. Is Pulsatility Index (PI) between 1 & 5? A PI greater than 5 is generally associated with low mean flow and systolic-dominant flow pattern indicating that the graft should be reexamined. Examine Graft • With Probe on the graft, turn on FlowSound® and listen for pitch increases as adjustments are made to the graft (1 octave pitch ‘K‘ = 4 ‘xK‘ in flow). • Look for kinks/twists in the graft, low MAP, dampened waveform • Redo anastomosis if technical error is indicated. Fig. 1: LIMA-LAD: mean = 147 mL/min; diastolic dominant; PI =2. Balanced Systolic/Diastolic Pattern In grafts to the right ventricle, flow is more equally distributed between the systolic and diastolic phases. This produces a flow waveform where the systolic peak may dominate but is followed by a proportionally strong diastolic flow producing a systolic/diastolic balanced waveform (Fig. 2). Fig. 2: RIMA - RCA: mean is 19 mL/min. systolic/diastolic balanced; PI=2 Questionable Flows For questionable mean graft flows (5 - 30 mL/min), the graft is evaluated through systolic/diastolic waveform properties, using FlowSound®, a printout or snapshot to examine the graft. A rule of thumb is that systole lasts one-third of a heart beat and diastole lasts two-thirds. Stenotic Pattern In stenotic grafts, the systolic peak dominates the flow profile and is associated with low or zero-mean flow. Often, systolic charge flow flows backwards as a negative flow during diastole (Fig. 3). Flow Waveform Analysis Diastolic-Dominant Pattern For grafts to the left ventricle, the shorter waveform peak is usually systolic, and the higher, broader peak is diastolic (Fig. 1) except in the presence of severe tachycardia where diastole is shortened. An acceptable left ventricular waveform is “diastolic dominant” where the delivered diastolic blood volume (i.e., area under diastolic curve) exceeds delivered systolic blood volume. CABGProtocol(CV-244-mn)RevD2014USltr Fig. 3: The RIMA - RCA graft exemplifies a graft with a stenotic flow profile. The flow waveform dips below zero and indicates the presence of competitive flow. Coronary Graft Patency Assessment Protocol Cont. Measure Graft Flow Evaluate Mean Flow Reading Questionable or Poor Flow < 15 mL/min (per mean flow chart) Examine Graft (spasm/kinks/twists/soft BP) Good Flow > 20 mL/min or > 30 mL/min (depending on a patient’s size and physiology) Remeasure Graft Flow with native coronary artery occluded (mean flow reading & waveform printout) Good Flow Reevaluate Mean Flow Reading (per mean flow chart) Acceptable Flow Profile Poor Flow < 5 mL/min Questionable Flow Flow Waveform Analysis • Acceptable Flow Profile: • Diastolic Dominant (left ventricle) • Systolic/Diastolic balanced (right ventricle) • Acceptable Pulsatility Index (1 - 5) Acceptable Graft Questionable Flow Profile Analyze Other Factors • Small patient/small target vessel? • Physiologic factors (MI, vasospasm, low MAP)? • Poor runoff? • Quality of myocardium? Suspect Graft Patent Graft Examine Graft for Anastomotic Error Proceed to measure flow in next graft Revise graft www.transonic.com Surgical Surgical AureFlo ® AureFlo ® The objective of vascular procedures is to re-establish adequate blood flow. But without definitive measurements, one doesn’t really know exact flow. Why rely on guesswork and intuition, and wait until postoperative conditions determine surgical success? Measure flow intraoperatively and generate flow waveforms for the operative record. Elevate your professional reputation with referring physicians, and protect your practice. Make intraoperative flow measurement with the AureFlo® System part of your routine. Verify adequate blood flow before closing your patient. “Not a day goes by that these flow measurements don’t solve a problem for me.” B. Mindich, MD “...at the Medical Center here, we use the flowprobe as part of our routine monitoring the post-bypass patient. It gives us intraoperatively information about what’s transpiring with each individual graft. It’s not information that you could get any other way.” E. Grossi, MD “Transonic Flow-QC provides a measurable improvement in the quality of care you can extend to your patients. You can: improve patient outcomes; reduce or delay the need for future interventions and document surgical results.” ® T.Wolvos, MD, FACS Transonic Systems Inc. is a global manufacturer of innovative biomedical measurement equipment. Founded in 1983, Transonic sells “gold standard” transit-time ultrasound flowmeters and monitors for surgical, hemodialysis, pediatric critical care, perfusion, interventional radiology and research applications. In addition, Transonic provides pressure and pressure volume systems, laser Doppler flowmeters and telemetry systems. www.transonic.com AMERICAS EUROPE ASIA/PACIFIC JAPAN Transonic Systems Inc. 34 Dutch Mill Rd Ithaca, NY 14850 U.S.A. Tel: +1 607-257-5300 Fax: +1 607-257-7256 [email protected] Transonic Europe B.V. Punterweg 31 6222 NW Maastricht The Netherlands Tel: +31 43-407-7200 Fax: +31 43-407-7201 [email protected] Transonic Asia Inc. 6F-3 No 5 Hangsiang Rd Dayuan, Taoyuan County 33747 Taiwan, R.O.C. Tel: +886 3399-5806 Fax: +886 3399-5805 [email protected] Transonic Japan Inc. KS Bldg 201, 735-4 Kita-Akitsu Tokorozawa Saitama 359-0038 Japan Tel: +81 04-2946-8541 Fax: +81 04-2946-8542 [email protected] Eliminate Guesswork... Replace intuition & optimism with volume flow measurements CV-53-fly Rev. E 8/13 AureFlo : Flow-Assisted Surgery to Optimize Outcomes ® C a r d i a c AureFlo T h o r a c i c N e u r o s u r g e r y V a s c u l a r •• Enhance operative notes and referral feedback Verify blood flow and graft quality with AureFlo®, a portable, integrated flow measurement system to continuously measure, display, and capture absolute volume flow and other derived parameters. Real-time feedback allows for quick assessment and immediate, intraoperative action. •• Review case recordings remotely •• Print selected waveforms for reference, analyzing, teaching or documenting into the patient record Save and review recordings to enhance operative notes. Photo ©Odua/Dreamstime.com Intuitive Operation Largest selection of non-constrictive application-specific Flowprobes •• Quick patient, procedure and vessel data entry •• Measure, capture, store and retrieve flow information Versatile Display •• Touch-screen PC uploaded with FlowTrace® software •• Easy to read, high contrast display AureFlo® display of recorded LIMA-LAD volume flow waveform (systolic flow volume in red; diastolic in blue). Also displayed are mean flow in mL/min, pulsatility index (PI), D/S Ratio, ECG tracing and heart rate. Convenient & Portable •• Small footprint, with large wheels for easy mobility •• Stable cart that securely holds Meter, Monitor & printer •• Includes a convenient writing surface and storage drawer Record, Display & Create Case Portfolios •• Recordings and snapshots can be labeled for identification before and after the procedure •• Select 8-second snapshots from recorded measurements for review or documentation •• Generous memory space allows storage of many cases Portfolio screen can display up to four snapshots at a time M i c r o s u r g e r y Archive & Retrieve ® •• Display can be connected to an OR monitor Tr a n s p l a n t Surgery Transonic Perivascular Flowprobes ® The widest selection of Flowprobes available Transonic’s application-customized Flowprobes measure volume flow in blood vessels and grafts from 0.5 mm to 36 mm to: •Quantify blood flow • Identify technical problems early • Improve patient outcomes FlowprobeFlyer(CV-500-fly)RevB 2014 Microvascular Flowprobes Flaps • Reattachments Transonic® Microvascular Flowprobes measure volume flow in blood vessels or grafts from 0.5 to 4.0 mm diameter. Flow measurement in these vessels during microvascular procedures quantify flows in the smallest vessels in order to objectively assess the quality of the reconstruction or replantation, guide better surgical decisions and give the surgeon the opportunity to correct otherwise undetectable flow restrictions before closing the patient. Due to extreme accuracy requirements, this Microvascular Flowprobe Series is only available with the Optima Flowmeter. Flexible neck Probe body Flowprobe handle Reflector Microvascular Flowprobe (2 mm) showing handle and flexible probe neck for easy positioning of the Flowprobe around a vessel. 0.7 mm 1.0 mm 1.5 mm 2.0 mm 3.0 mm Ultrasonic sensing windows of Microvascular Flowprobe (MU) Series. Side-by-side comparison of a 0.7 mm Flowprobe with a tip of a 25g. needle. Microvascular Flowprobe (-MU) Series including 0.7 mm, 1 mm, 1.5 mm, 2 mm, and 3 mm Flowprobes. Cardiac Flowprobes Coronary Artery Grafts • Ascending Aorta Transonic® Cardiac Flowprobes include FMC-Series Flowprobes for coronary artery bypass grafting surgery and COnfidence Flowprobes® for continuous measurement on great vessels with turbulent flows. Coronary Flowprobes Elongated curved neck Probe body Probe handle Flexible neck segment FMC-Series Coronary Handle Flowprobes are available in sizes 1.5 mm to 4 mm. They feature a J-style reflector, designed for spot flow checks of coronary artery bypass grafts and an extended neck with a flexible end to reach coronary grafts even behind the heart. COnfidence Flowprobes® Probe shell Ultrafit liner COnfidence Flowprobes consist of a Flowprobe shell and a single-use soft, flexible Ultrafit liner. This novel concept for ultrasonic signal coupling enables immediate, accurate beat-to-beat flow measurements with a minimum of ultrasonic coupling gel. The form-fitting Ultrafit Liner slips into the transducer shell to encircle the vessel and keep the vessel in place. The liner cushions and protects the vessel during a flow measurement. Liners are incrementally sized for optimal fit on the target vessel. ® Pictured, from left to right, are 1.5 mm, 2 mm, 3 mm and 4 mm coronary Flowprobes showing their blue Probe bodies, J reflectors and ultrasonic sensing windows. 28 mm 20 mm 16 mm 14 mm 12 mm 10 mm 8 mm 24 mm COnfidence Flowprobes® (-AU-Series), designed with four transducers, provide highly accurate measurements in vessels with highly turbulent flows such as the ascending aorta. The Flowprobe’s slim, ergonomic profile creates a minimal footprint that fits in tight anatomical sites. The soft, pliable liner cushions and protects the vessel. Available in 15 sizes from 8 mm to 36 mm. Port-Access Flowprobes Port-Access Flowprobes, a customer-driven innovation, feature a long endoscopic handle to extend through robotic ports and measure flows on coronary grafts. They are available in three sizes: 2 mm, 3 mm, and 4 mm. Vascular Flowprobes Peripheral Vascular • Carotid Endarterectomy Transonic’s spectrum of Vascular Flowprobes measure volume flows intraoperatively in vessels and grafts from 0.5 mm to 20 mm to detect blood flow obstructions before leaving the operating room. This ability to correct otherwise undetectable flow restrictions provides the surgeon with a unique opportunity to improve the outcome for his or her patient. Handle Vascular Flowprobes Probe body J Reflector Flexible neck Handle Short Handle Vascular Flowprobes: The FMV-Series features a short handle and a J reflector designed for spot flow checks. Available in a wide range of sizes from 1.5 mm to 14 mm. Carotid Flowprobes Non-handle Flowprobes Sliding cover Probe body L reflector L reflector Flexible neck FME-Series Flowprobes feature an L-shaped reflector to protect against dislodging of plaque (such as during carotid endarterectomy) as the Flowprobe is applied. The L reflector design allows the probe to be slipped on and off a carotid artery easily, facilitating quick pre- and post-procedure measurements. Available in 1.5 mm to 10 mm sizes. Non-Handle Flowprobes (FSB-Series) feature an ultrasonic flowsensing window defined by an L reflector with a sliding cover so that the Flowprobe can remain positioned around the vessel for extended measurements. FSB-Series Flowprobes are available in sizes from 2 mm to 14 mm. OptiMax® Flowprobes ® The OptiMax® family with J reflectors (shown) and L reflectors (not shown) are available in 4, 6, 8, 10 and 12 mm. OptiMax Flowprobes’ two reflector shapes and multiple probe sizes accommodate different surgical preferences and patient anatomies. The skin tabs secure the Flowprobe so that continuous measurements can guide vascular constructions, banding or revisions until a target flow is achieved. Cerebrovascular Flowprobes Aneurysm Clipping • EC-IC Bypass • AVMs • Fistulas Transonic® Cerebrovascular (Charbel) Flowprobes measure volume flow in intracranial and extracranial vessels during cerebrovascular flow preservation or flow augmentation surgeries. Intraoperative measurements of volume flow assure the integrity of flow in cerebral vessels or they alert the surgeon to dangerous flow deficits at a time when every minute counts. Intracranial Flowprobes Flexible neck Probe body Long bayonet neck Reflector Probe head Close-up Long bayonet neck Long bayonet neck intracranial Charbel Micro-Flowprobes® are available in three sizes, 1.5 mm, 2 mm and 3 mm, for aneurysm clipping, AVM and dural fistula obliteration surgeries. -MB & -MR-Series Charbel Micro-Flowprobes® are designed to measure flow in major intracranial vessels of the Circle of Willis. Their long bayonet neck permits use under a surgical microscope and a flexible neck segment permits bending the Flowprobe as needed to most easily position the probe around the vessel. Extracranial Flowprobes Short bayonet neck Short bayonet neck extracranial Charbel Probes® are available in three sizes, 3 mm, 4 mm and 6 mm, for extracranial vessels such as the superior temporal artery during extracranial-intracranial (EC-IC) bypass surgeries. Their short bayonet neck permits use under a surgical microscope and a flexible neck segment permits bending the Flowprobe as needed to most easily position the probe around the vessel. Side-by-side comparison between intracranial Charbel Micro-Flowprobes® and shorter neck extracranial Charbel Flowprobes® used during EC-IC bypass surgery. Surgery Transplant Flowprobes Liver • Renal • Heart/Lung • Pancreas Transonic® Flowprobes work with HT300-Series Flowmeters to measure volume flow in blood vessels and grafts from 0.5 to 36.0 mm. In critical transplant surgeries, intraoperative measurement of flow in vessels can guide surgical decisions to ensure vessel patency prior to closing. Probe body Flexible neck Reflector Handle FMV-Series 4 and 6 mm Vascular Flowprobes recommended for measuring hepatic arterial flow. Picture shows Flowprobe handle with size of Probe in mm, the Probe’s flexible neck for optimal positioning of the Probe around the vessel, the Probe body that houses the ultrasonic transducers, and the Probe reflector. Vessel is positioned within the Probe sensing window that is defined by the Probe body and its stationary reflector. Vascular Flowprobes (FMV-Series) in sizes 8 mm to 14 mm are used for spot portal venous flow measurements. COnfidence Flowprobes® (-AU-Series) can also be used for continuous portal venous flow measurements. Transonic Systems Inc. is a global manufacturer of innovative biomedical measurement equipment. Founded in 1983, Transonic sells “gold standard” transit-time ultrasound flowmeters and monitors for surgical, hemodialysis, pediatric critical care, perfusion, interventional radiology and research applications. In addition, Transonic provides pressure and pressure volume systems, laser Doppler flowmeters and telemetry systems. www.transonic.com AMERICAS EUROPE ASIA/PACIFIC JAPAN Transonic Systems Inc. 34 Dutch Mill Rd Ithaca, NY 14850 U.S.A. Tel: +1 607-257-5300 Fax: +1 607-257-7256 [email protected] Transonic Europe B.V. Business Park Stein 205 6181 MB Elsloo The Netherlands Tel: +31 43-407-7200 Fax: +31 43-407-7201 [email protected] Transonic Asia Inc. 6F-3 No 5 Hangsiang Rd Dayuan, Taoyuan County 33747 Taiwan, R.O.C. Tel: +886 3399-5806 Fax: +886 3399-5805 [email protected] Transonic Japan Inc. KS Bldg 201, 735-4 Kita-Akitsu Tokorozawa Saitama 359-0038 Japan Tel: +81 04-2946-8541 Fax: +81 04-2946-8542 [email protected] Surgery Flowprobe Selection Guide PERIVASCULAR FLOWPROBE SERIES & AVAILABLE SIZES SUFFIX DESCRIPTION SIZES (mm) -FMC Coronary 1.5, 2, 3, 4 -FMV Vascular 1.5, 2, 3, 4, 6, 8, 10, 12, 14 -FME Carotid (L-reflector for carotid endarterectomy) 1.5, 2, 3, 4, 6, 8, 10 -FTV OptiMax (hands-free, J-reflector) 4, 6, 8, 10, 12 -FTE OptiMax (hands-free, L-reflector carotid endarterectomy) 4, 6, 8, 10, 12 -MU Microvascular (handle) 0.7, 1, 1.5, 2, 3 -AU Cardiac Output COnfidence Flowprobe 8, 10, 12, 14, 16, 20, 24, 28, 32, 36 -MB Intracranial Charbel Micro-Flowprobe® (long bayonet handle) 1.5, 2, 3 -MB-S Extracranial EC-IC Bypass: Micro-Flowprobe (short bayonet handle) 3, 4, 6 -FSB Basic (no handle, L-reflector, sliding cover) 1.5, 2, 3, 4, 6, 8, 10, 12, 14 ® ® ® Recommended Sizes and/or Flowprobe Series for Specific Vessels or Applications CARDIAC SURGERY CABG: ON OR OFF PUMP Probe Size (mm) VASCULAR SURGERY Probe Series Arterial conduits 1.5, 2, 3, 4 -FMC Saphenous vein 2, 3, 4 -FMC CARDIAC OUTPUT Ascending aorta 28, 32, 36 -AU Pulmonary artery 24, 28, 32 -AU Pediatric heart 8, 10, 12, 14, 16, 20 -AU TRANSPLANT SURGERY Probe Size LIVER (mm) Probe Series CAROTID ENDARTERECTOMY Probe Size (mm) Common carotid artery 8, 10 -FTE -FME -FSB External carotid artery 6 -FTE -FME -FSB Internal carotid artery 6 -FTE -FME -FSB Radial artery 2, 3 -FMV Brachial artery 3, 4, 6 -FMV -FTV -FSB Graft venous outflow 4, 6 -FMV -FTV -FSB 4, 6 -FMV -FTV -FSB AV FISTULAS & GRAFTS Renal bypass 4, 6, 8 -FMV -AU Portal vein 10, 12, 14 -FMV -AU Renal artery 4, 6 -FMV -FSB Renal vein 10 -FMV -FSB External iliac artery 6, 8 -FMV -FSB LOWER EXTREMITY BYPASS Hypogastric artery 4, 6 -FMV -FSB 8 -FMV -FSB PANCREAS Common iliac artery CEREBROVASCULAR SURGERY ANEURYSM CLIPPING Cerebral arteries Probe Size (mm) Probe Series 1.5, 2, 3 -MB -MR Extracranial 3, 4, 6 -MB-S MR-S Intracranial 1.5, 2, 3 -MB -MR EC-IC BYPASS -FSB ABDOMINAL Hepatic artery KIDNEY Probe Series Aortoiliac shunt aorta 16, 20 -AU -FSB common iliac 10, 12 -FMV -FTV -AU -FSB Portocaval shunt 10, 12, 14 -FMV -FTV -AU -FSB Splenorenal shunt 10, 12, 14 -FMV -FTV -AU -FSB Profunda femoris 8 -FMV -FTV -AU -FSB Common femoral 8, 10 -FMV -FTV -AU -FSB Popliteal 4, 6 -FMV -FTV -FSB Tibial 3, 4 -FMV -FTV -FSB MICROVASCULAR SURGERY REATTACHMENTS/FLAPS Probe Size (mm) Probe Series Microvessels in hand, wrist 0.7, 1, 1.5, 2, 3 -MU AVM, TUMOR RESECTION, DURAL FISTULA Outflows variable FlowprobeSelectionGuide(CV-66-tn)RevE 2014 -MB, -MR www.transonic.com
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