A novel all-retrograde approach for t-Branch implantation in ruptured thoracoabdominal aneurysm

Abstract

The off-the-shelf t-Branch device (Cook Medical, Bloomington, Ind) significantly advanced the endovascular treatment of ruptured thoracoabdominal aortic aneurysms. Improved techniques for expeditious implantation of the t-Branch may improve clinical outcomes for this emergent procedure. Currently, implantation is described using axillary and femoral access. We describe the repair of a ruptured thoracoabdominal aortic aneurysm exclusively through femoral access aided by a steerable sheath and newer generation, low-profile bridging stents.

Total Percutaneous Femoral Approach for Branched Custom-Made Device Endovascular Repair of Thoracoabdominal Aneurysm

“…This is a less ergonomic working position with cross-over communication among teams and higher risk of radiation exposure for the team situated at the upper limb. 9) The use of the steerable sheath allows total percutaneous access from the femorals, thus avoiding access from the upper limb and possible complications described above. The steerable tip of the sheath supports appropriate angulation to be formed in relation to the origin of the branch and assists further cannulation of the target vessel.…”

“…This is a less ergonomic working position with cross-over communication among teams and higher risk of radiation exposure for the team situated at the upper limb. 9 )…”

Recanalization and Stenting of the Celiac and the Superior Mesenteric Artery Supported by Use of a Steerable Introducer Sheath: Report on 2 Years’ Experience

“…Except these publications, literature is limited to technical notes or case reports regarding branched or fenestrated EVAR 12 -16 or the deployment of hypogastric bridging stent 17 or iliac branch device 18 after EVAR. Otherwise, at the best of our knowledge, this is the first systematic report on the usage of these introducer sheaths in the recanalization of stenotic visceral arteries not involving EVAR.…”

New Technical Approach to Overcome Anatomical Challenges During Branched Endovascular Aortic Repair with off-the-Shelf Multibranched Stent-Grafts: Are We Sequentially and Progressively Scraping the Sky?

“…Also, the SCAPED approach invariably requires use of upper arm access (UEA); although usually safe, UEA is a risk factor for post-procedural stroke [5] and one case (5%) of peri-operative stroke was reported in the series of Malekpour et al Recently, the feasibility of totally transfemoral t-Branch implantation has been demonstrated using novel steerable sheaths [6]. The main advantage of a totally retrograde approach to BEVAR procedures would be the minimization of aortic arch crossing with endovascular tools thereby reducing the risk of cerebral embolization, as well as the possibility of expanding t-Branch applicability to those patients without available UEA.…”