Branched Thoraco-Abdominal Aortic Aneurysm Repair with Branch Access Through a Transapical Left Ventricular Approach

Helmy, Amir; Catarino, Pedro; Dunning, John; Hayes, Paul D.; Goon, S.; Winterbottom, Andrew

doi:10.1007/s00270-018-1973-5

Cited by 2 publications

(4 citation statements)

References 14 publications

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“…While fenestrations can usually be catheterized from a femoral approach, downward facing branches are the method of choice to engage visceral vessels originating from aneurysmatic parts of the aorta [ 7 ]. These branches traditionally require an axillary or brachial arterial approach for catheterization from above [ 8 – 10 ]. Apart from offering a better sealing between the main body and stentgraft inside the aneurysm, branches also offer more variability to catheterize the visceral arteries, which has led to the introduction of off-the-shelf devices suitable for the majority of patient anatomies [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Use of a Steerable Sheath for Completely Femoral Access in Branched Endovascular Aortic Repair Compared to Upper Extremity Access

Hauck

Eilenberg

Kupferthaler

et al. 2022

Cardiovasc Intervent Radiol

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Purpose To compare bridging stent graft (BSG) implantation in downward oriented branches in branched endovascular aortic repair (bEVAR), using a commercially available steerable sheath from an exclusively femoral access (TFA) with traditional upper extremity access (UEA). Methods In a retrospective cohort study, 7 patients with 19 branches in the TFA cohort received BSG insertion using the Medtronic Heli FX steerable sheath from a femoral access, and 10 patients with 32 branches in the UEA cohort from a brachial approach. Technical success, total intervention time, fluoroscopy time, branch cannulation time, and complication rate were recorded. Results Technical success was 19/19 branches in the TFA and 31/32 in the UEA cohort. The mean branch cannulation time was considerably shorter in the TFA group (17 vs. 29 min, p = 0.003), and total intervention time tended to be shorter (169 vs. 217 min, p = 0.176). Conclusion Using a commercially available steerable sheath allowed successful cannulation of all branches in this cohort and was associated with significantly shorter branch cannulation times. Potentially, this technique can lower the stroke and brachial puncture site complication risk as well as reduce total intervention time and radiation dose. Level of Evidence 2b, retrospective cohort study.

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Section: Introductionmentioning

confidence: 99%

Use of a Steerable Sheath for Completely Femoral Access in Branched Endovascular Aortic Repair Compared to Upper Extremity Access

Hauck

Eilenberg

Kupferthaler

et al. 2022

Cardiovasc Intervent Radiol

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“…Whenever standard arterial accesses are not available, one could consider transapical left ventricular approach as previously reported by other authors. 4 The left ventricular apex is an alternative access route which is commonly used for percutaneous aortic valve replacement and rarely used for F-BEVAR. However, this approach may render the patients with a higher rate of complications including major bleeding, pericardial effusion, arrhythmia and left ventricular aneurysm.…”

Section: Discussionmentioning

confidence: 99%

“…However, this approach may render the patients with a higher rate of complications including major bleeding, pericardial effusion, arrhythmia and left ventricular aneurysm. 4 Patients who need urgent repair of symptomatic or large TAAAs are not suitable candidates for custom made fenestrated or branched devices. The long waiting time for manufacturing is prohibitive.…”

Section: Discussionmentioning

confidence: 99%

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Multi-Branched Thoracoabdominal Endovascular Aortic Repair With Branch Access Through a Left Thoracotomy and Descending Thoracic Aortic Conduit: A Novel and Effective Alternative Access

Ferreira¹,

Mannarino²,

Cunha³

et al. 2022

J Endovasc Ther

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Purpose: To demonstrate an alternative access to perform directional branch catheterization during complex endovascular aortic repair. Technique: Urgent endovascular aortic repair was indicated to treat a symptomatic post dissection thoracoabdominal aneurysm with large infrarenal dilatation with an off-the-shelf t-Branch endograft (Cook Medical, Bloomington, IN, USA). Traditional proximal arterial accesses were not suitable due to a previous aortic arch endograft. A novel approach was performed through a left postero-lateral thoracotomy, isolation of the descending thoracic aorta and anastomosed a polyester graft conduit to allow sheaths passage to the thoracoabdominal aorta with subsequently directional branch catheterization. Conclusion: The descending thoracic aortic conduit technique is an effective alternative for directional branch catheterization and should be considered whenever traditional proximal arterial accesses are not suitable and other endografts configurations not considered due to anatomic limitations.

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Branched Thoraco-Abdominal Aortic Aneurysm Repair with Branch Access Through a Transapical Left Ventricular Approach

Cited by 2 publications

References 14 publications

Use of a Steerable Sheath for Completely Femoral Access in Branched Endovascular Aortic Repair Compared to Upper Extremity Access

Use of a Steerable Sheath for Completely Femoral Access in Branched Endovascular Aortic Repair Compared to Upper Extremity Access

Multi-Branched Thoracoabdominal Endovascular Aortic Repair With Branch Access Through a Left Thoracotomy and Descending Thoracic Aortic Conduit: A Novel and Effective Alternative Access

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