Ceiling Technique to Facilitate Target Vessel Catheterization During Complex Aortic Repair

Simonte, Gioele; Isernia, Giacomo; Fino, Gianluigi; Baccani, Luigi; Fino, Andrea; Casali, Francesco; Lenti, Massimo

doi:10.1016/j.avsg.2020.09.011

Cited by 2 publications

(2 citation statements)

References 8 publications

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“…There are several previously described endovascular maneuvers that can facilitate vessel catheterization during aneurysm aortic repair. 16,17 However, the challenging condition in the present case was not limited to catheterization of the target vessels, but also involved maintenance of the diagnostic catheter during guidewire exchange, due to the intense aortic tortuosity. This is a commonly faced situation during endovascular repair and demands creative technical solutions.…”

Section: Discussionmentioning

confidence: 91%

A novel balloon-assisted technique to secure visceral catheterization during a chimney endovascular repair of a ruptured abdominal aortic aneurysm in a centenarian patient

Galastri,

Valle,

Cunha

et al. 2023

J. vasc. bras.

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A 100-year-old male patient was admitted with a ruptured abdominal aortic aneurysm due to type IA endoleak. Given the proximity of the ruptured site to the superior mesenteric artery (SMA) and renal arteries, a ChEVAR was indicated. Catheterization of the target visceral vessels was a challenging procedural step because of an intensely tortuous thoracic aorta. This hostile aortic anatomy also inhibited exchange for a super stiff guide-wire and selective cannulation with the diagnostic catheter was repeatedly lost when guidewire exchange was attempted. To overcome this issue, a 5 x 40 mm balloon catheter was placed 3cm into the target arteries. The balloon was then inflated below the nominal pressure limit enabling safe exchange for a super stiff guidewire and placement of three 90-cm long 7Fr guiding sheaths. The procedure was thus safely performed with deployment of an aortic extension and the bridging stents.

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Section: Discussionmentioning

confidence: 91%

A novel balloon-assisted technique to secure visceral catheterization during a chimney endovascular repair of a ruptured abdominal aortic aneurysm in a centenarian patient

Galastri,

Valle,

Cunha

et al. 2023

J. vasc. bras.

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“…Although the vessel cannulation was performed regularly, the advancement of the covered stent was impaired due to protruding edge of previously positioned covered stent in aortic lumen, requiring hazardous additional maneuvers like double wire cannulation and stenting from above with a help of the modified ceiling technique with a compliant balloon from below to support stent advancement. 10 After complete visceral stenting the main endograft was fully deployed and the procedure completed using standard procedural steps.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Unsuspected Limitations of 3D Printed Model in Planning of Complex Aortic Aneurysm Endovascular Treatment

Bonvini,

Raunig,

Demi

et al. 2024

Vasc Endovascular Surg

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Objective Static 3-dimensional (3D) printing became attractive for operative planning in cases that involve difficult anatomy. An interactive (low cost, fast) 3D print allowing deliberate surgical practice can be used to improve interventional simulation and planning. Background Endovascular treatment of complex aortic aneurysms is technically challenging, especially in case of narrow aortic lumen or significant aortic angulation (hostile anatomy). The risk of complications such as graft kinking and target vessel occlusion is difficult to assess based solely on traditional software measuring methods and remain highly dependent on surgeon skills and expertise. Methods A patient with juxtarenal AAA with hostile anatomy had a 3-dimensional printed model constructed preoperatively according to computed tomography images. Endovascular graft implantation in the 3D printed aorta with a standard T-Branch Cook (Cook® Medical, Bloomington, IN, USA) was performed preoperatively in the simulation laboratory enabling optimized feasibility, surgical planning and intraoperative decision making. Results The 3D printed aortic model proved to be radio-opaque and allowed simulation of branched endovascular aortic repair (BREVAR). The assessment of intervention feasibility, as well as optimal branch position and orientation was found to be useful for surgeon confidence and the actual intervention in the patient. There was a remarkable agreement between the 3D printed model and both CT and X-ray angiographic images. Although the technical success was achieved as planned, a previously deployed renal stent caused unexpected difficulty in advancing the renal stent, which was not observed in the 3D model simulation. Conclusion The 3D printed aortic models can be useful for determining feasibility, optimizing planning and intraoperative decision making in hostile anatomy improving the outcome. Despite already offering satisfying accuracy at present, further advancements could enhance the 3D model capability to replicate minor anatomical deformities and variations in tissue density.

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Ceiling Technique to Facilitate Target Vessel Catheterization During Complex Aortic Repair

Cited by 2 publications

References 8 publications

A novel balloon-assisted technique to secure visceral catheterization during a chimney endovascular repair of a ruptured abdominal aortic aneurysm in a centenarian patient

A novel balloon-assisted technique to secure visceral catheterization during a chimney endovascular repair of a ruptured abdominal aortic aneurysm in a centenarian patient

Unsuspected Limitations of 3D Printed Model in Planning of Complex Aortic Aneurysm Endovascular Treatment

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