Balloon-assisted techniques for advancing long sheaths through difficult anatomy.

We describe two balloon-assisted techniques to facilitate the advancement of large, long sheaths through freshly placed stents or tortuous anatomy. The first technique uses a balloon inflated while partially housed within the sheath to help clear an edge, thus offering resistance. The second uses an angioplasty balloon inflated in a distal pulmonary artery branch to better anchor the wire while advancing the sheath through a tortuous path. The techniques are illustrated by the cases of four patients, including two undergoing Melody valve (Medtronic, Minneapolis, MN) implantation.