Rarely does an introducer sheath truly stand out for its ability to improve vascular patient care, as for many years, the available sheath technologies had very comparable attributes and abilities. However, the GORE DrySeal Sheath (W. L. Gore & Associates, Flagstaff, AZ) is a unique exception, and it is elite among the class of large-bore introducer sheaths for a variety of reasons (Figure 1).

Paramount among these is the exceptional ability of the GORE DrySeal Sheath to adapt to a number of different devices and allow multiple exchanges while maintaining hemostasis despite the large caliber of the sheath. The sheath is pressurized to create a seal, and no manipulation is required on the part of the physician to maintain hemostasis.

The hemostasis allowed by this device decreases procedural blood loss and reduces the potential need for transfusion. Before I began using the GORE DrySeal Sheath, blood loss was a significant issue with other largebore sheaths, with a frequent need for transfusion. With this sheath, I have found the need for transfusion to be very infrequent. It also helps to prevent blood loss complications such as hypotension throughout the case. Other sheaths that are used during the endovascular repair of abdominal aortic aneurysms (EVAR) and thoracic aortic aneurysms (TEVAR) have been aimed more at “hemoreduction” than hemostasis, and they continue to have issues during and between device exchanges. The compliant ePTFE film liner of the GORE DrySeal Valve has advanced beyond that with excellent results.

The GORE DrySeal Sheath is helpful in any type of aortic intervention, but its utility is particularly noted in challenging or complicated cases because of its ability to accommodate multiple catheters and wires through a single sheath. As a result, we can frequently avoid the need to create a separate access in the contralateral groin because everything can be done via one sheath.

In addition to providing excellent hemostasis, the sheath is easy to use, and its caliber and taper are well suited for accessing difficult vessels. This facility, combined with the ability to introduce multiple devices through a single sheath, makes the GORE DrySeal Sheath less traumatic to the vessel, therefore decreasing patient morbidity from potential catastrophic sheath-related injuries. It has allowed me to take on more challenging cases, because with the myriad of other procedural conditions that require monitoring and attention, I can be confident that access will not be an issue.

In comparison to products that have been available in the past, the GORE DrySeal Sheath is a quantum leap in sheath technology. In my opinion, other large-bore sheaths do not compare.

Robert C. Allen, MD, is with Hawthorne Cardiothoracic & Vascular Surgeons in Charlotte, North Carolina. He has disclosed that he holds no financial interest in any product or manufacturer mentioned herein. Dr. Allen may be reached at rcallen@novanthealth.org.