The “Destino-guided BEVAR” to Catheterize Downward Branches from a Femoral Access: Technical Note and Case Report

Orrico, Matteo; Ronchey, Silvia; Setacci, Carlo; Marino, Mario; Vona, Alessio; Lorido, Antonio; Nesi, Fabrizio; Giaquinta, Alessia; Mangialardi, Nicola

doi:10.1016/j.avsg.2018.09.044

Cited by 20 publications

(19 citation statements)

References 7 publications

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“…1 Recently, an alternative retrograde approach using transfemoral access (TFA) and steerable sheaths was proposed to reduce the risk of these UEA-related complications. [4][5][6] The main initial challenge with TFA was the limited stability of the curvature of the steerable sheath, especially during passage of the bridging covered stent. To overcome this limitation, we recently introduced the use of a preloaded suture inside the sheath to increase the stability of the bent tip.…”

mentioning

confidence: 99%

Comparison of transfemoral versus upper extremity access to antegrade branches in branched endovascular aortic repair

Eilenberg

Kölbel

Rohlffs

et al. 2021

Journal of Vascular Surgery

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mentioning

confidence: 99%

Comparison of transfemoral versus upper extremity access to antegrade branches in branched endovascular aortic repair

Eilenberg

Kölbel

Rohlffs

et al. 2021

Journal of Vascular Surgery

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Pedersoli

Hitpaß

Isfort

et al. 2020

Vasc Endovascular Surg

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Purpose: To compare technical parameters and success of recanalization of celiac (CA) or superior mesenteric artery (SMA) with usage of steerable vs not steerable introducer sheaths. Methods: A retrospective analysis was performed on all consecutive patients who underwent recanalization with stent implantation of CA or SMA between 2015 and 2019. Data regarding technical success (successful stent placement with restoration of sufficient blood flow by the first attempt without changing kind of introducer sheath or access site), indication for treatment, vascular access, kind of introducer sheath, fluoroscopy time and radiation dose were collected. Preinterventional CT were analyzed to classify the difficulty of catheterization of target vessels. Technical parameters were compared with independent t-test (p ≤ 0.05). Results: 66 patients underwent recanalization of CA or SMA. Usage of steerable introducer sheaths was associated with higher technical success compared to not steerable introducer sheaths with transfemoral approach respectively of 8/8 vs 15/19 for the CA and 11/11 vs 17/20 for the SMA. Steerable introducer sheaths were used in recanalization considered more technically difficult compared to not steerable introducer sheaths (58% vs 33%). Usage of steerable introducer sheath showed a statistically significant reduction of radiation dose in the recanalization of the SMA (respectively 32035 ± 15716 cGy cm2 vs 60102 ± 28432 cGy cm2; p = 0.005). Conclusion: Even if used in more difficult interventions, steerable introducer sheaths showed a higher technical success compared to not steerable introducer sheaths with transfemoral access.

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“…While different authors have suggested the use of steerable sheaths during different complex endovascular aortic repairs, [1][2][3][4][5] the stability of this vascular access is probably its main drawback. The combination of suture and catheter is commonly employed for locking-loop drains in several interventional procedures outside the vascular system.…”

Section: Discussionmentioning

confidence: 99%

“…Retrograde transfemoral access using a steerable sheath has been recently suggested from different centers as an alternative approach to overcome the need for a brachial access to catheterize antegrade branches in branched endovascular aortic repair (BEVAR). [1][2][3] Potential advantages of a fully transfemoral access in BEVAR include reduced invasiveness without the need for a transbrachial access, reduced radiation exposure, and an improved workflow. The use of this technique in our experience has rapidly increased.…”

Section: Introductionmentioning

confidence: 99%

Through-and-Through Suture Technique to Stabilize a Sheath in Branched Endovascular Aortic Repair

et al. 2019

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Purpose: To describe a technique to catheterize antegrade branches of a branched thoracoabdominal endograft from a femoral access with the help of standard sheaths and a vascular suture. Technique: The technique is demonstrated in a patient who underwent successful complex thoracoabdominal branched endovascular aortic repair. After the deployment of an aortic endograft with two antegrade branches for the targeted renovisceral vessels, a standard braided sheath was preloaded with a 3/0 polypropylene suture and introduced inside an additional sheath from the groin to the thoracic aorta. Simultaneous gentle traction on the suture as the preloaded sheath was advanced achieved a very stable 180° curve of the proximal end of the sheath. It was possible to selectively catheterize the antegrade branches and respective target vessels sequentially, as well as deploy the planned bridging stents for each branch. Conclusion: The through-and-through suture technique is a helpful tool in branched endovascular aortic repair. It saves time, radiation, and materials; no snare is needed, and it can be preloaded into a sheath.

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The “Destino-guided BEVAR” to Catheterize Downward Branches from a Femoral Access: Technical Note and Case Report

Cited by 20 publications

References 7 publications

Comparison of transfemoral versus upper extremity access to antegrade branches in branched endovascular aortic repair

Comparison of transfemoral versus upper extremity access to antegrade branches in branched endovascular aortic repair

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

Through-and-Through Suture Technique to Stabilize a Sheath in Branched Endovascular Aortic Repair

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