Use of a Steerable Sheath for Retrograde Access to Antegrade Branches in Branched Stent-Graft Repair of Complex Aortic Aneurysms

Makaloski, Vladimir; Tsilimparis, Nikolaos; Rohlffs, Fiona; Σπανός, Κωνσταντίνος; Debus, Eike Sebastian; Kölbel, Tilo

doi:10.1177/1526602818794965

Cited by 76 publications

(59 citation statements)

References 15 publications

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“…The antegrade branches were catheterized from the right CFA access using a 10.5-F Destino steerable sheath (Oscor, Palm Harbor, FL, USA) through a 22-F, 25-cm Check-Flo sheath (Cook Medical) in order to gain better stability. 8 The steerable sheath was positioned at the branch origin; the orifice of the TV was visualized on DSA (Figure 5B) and catheterized with a hydrophilic guidewire that was exchanged for a 180-cm Rosen guidewire (Cook Medical Europe). The branch was bridged with a self-expanding covered stent (Viabahn; Gore Medical, Flagstaff, AZ, USA).…”

Section: Case Reportmentioning

confidence: 99%

Endovascular Repair Using a 7-Branch Stent-Graft for a Thoracoabdominal Aortic Aneurysm With Variant Renovisceral Artery Anatomy

et al. 2019

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Purpose: To present a case of endovascular repair using a custom-made 7-branch stent-graft for a thoracoabdominal aortic aneurysm (TAAA) in a patient with variations in the renovisceral artery anatomy. Case Report: A 70-year-old asymptomatic man presented with a 60-mm-diameter type IV TAAA. Due to severe coronary artery disease, an endovascular approach was elected. In the preoperative computed tomography angiography (CTA) scans, variations in the renovisceral artery anatomy included the common hepatic and splenic arteries deriving separately from the aorta and bilateral double renal arteries (RAs). A custom-made 7-branch stent-graft was manufactured to preserve all renovisceral arteries. The 7 branches were catheterized and connected with a steerable sheath from a femoral access. All branches were bridged to the target vessel (TV) with a self-expanding covered stent; 4 TVs also had balloon-expandable covered stents implanted. Final angiography and predischarge CTA showed patency of all 7 target vessels and corresponding visceral organs, with no endoleak. The patient was discharged on postoperative day 8 without complications. Six-month follow-up CTA demonstrated exclusion of the TAAA and patency of all 7 target vessels. Conclusion: Successful treatment of a TAAA in a patient with multiple variant renovisceral arteries was feasible with a custom-made 7-branch stent-graft, achieving a good early outcome.

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Section: Case Reportmentioning

confidence: 99%

Endovascular Repair Using a 7-Branch Stent-Graft for a Thoracoabdominal Aortic Aneurysm With Variant Renovisceral Artery Anatomy

et al. 2019

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“…Makaloski et al [3] were the first to report 4 cases in which they used a retrograde access with a steerable sheath to complete antegrade branches. They emphasized stability, pushability and torquebility of the steerable sheath.…”

Section: Discussionmentioning

confidence: 99%

“…The group of Makaloski et al [3] recently published a paper to describe a retrograde access to antegrade branches with steerable sheaths. We also used this technique over the recent years.…”

Section: Introductionmentioning

confidence: 99%

Improved stability of steerable sheath access by femoro-femoral crossover wire in branched stent graft repair of complex thoraco-abdominal aortic aneurysms

Töpel

Betz

Steinbauer

et al. 2020

Innovative Surgical Sciences

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PurposeThe purpose of this study was to describe a technique to catheterize antegrade branches of a branched aortic endograft by using a steerable sheath stabilized by a through-and-through wire via a femoral access.TechniqueAfter implantation of a branched endovascular graft, a steerable 8.5 F sheath is advanced from the femoral access. After placing the sheath proximal to the branches, a 0.014″ through-and-through wire is established to the contralateral femoral access which is held under slight traction after the curved tip of the sheath is brought into the 180° position. Then catheterization, wire exchange and deployment of the bridging stent is done in standard fashion.ConclusionThe use of a through-and-through wire with a steerable sheath for retrograde femoral access adds stability and precision to this technique. It has the potential to reduce the risk of preoperative stroke in complex aortic endovascular repair by avoiding upper extremity access.

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“…B. 3-fach gebranchte Aortendesigns mit retrogradem Branch für die linke A. subclavia [30] sowie der transfemorale Zugang für die Besetzung der Branches bei Versorgung mit gebranchten Prothesen [31].…”

Section: Erweiterte Endovaskuläre Versorgung Mit Fb-tevar Und Fb-evarunclassified

Aortenaneurysma: fenestrierte/gebranchte abdominale EVAR (fbEVAR) und fenestrierte/gebranchte thorakale EVAR (fbTEVAR). Ist die komplette endovaskuläre Therapie schon da?

Mehmedovic¹,

Konstantinou²,

Jerkku³

et al. 2020

Zentralbl Chir

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ZusammenfassungFünf Jahre nach der ersten endovaskulären Aortenrekonstruktion (EVAR) berichten Park et al. über die erste Implantation einer fenestrierten Endoprothese. In der Zwischenzeit wurden mehrere fortgeschrittene Generationen von fenestrierten und gebranchten Prothesen entwickelt. Diese können in den meisten Fällen in 2 Gruppen unterteilt werden. Zur 1. Gruppe gehören die „custom-made“-Prothesen, die für elektive Operationen individuell für Patienten mit spezifischer Anatomie hergestellt werden. Eine 2. Gruppe bilden die sog. „off-the-shelf“-Prothesen, die sich durch vom Hersteller vergebene Charakteristika im Sinne von Länge, Breite und Durchmesser auszeichnen und bei allen Prothesen gleich sind. Die offene gefäßchirurgische Therapie der thorakoabdominellen Aortenaneurysmen ist selbst bei elektiven Eingriffen mit relevanter Mortalität und Morbidität assoziiert. Die Entwicklung von endovaskulären Modalitäten wie z. B. fenestrierte oder gebranchte endovaskuläre Aortenrekonstruktionen (F-EVAR, B-EVAR) ermöglichten die Nutzung weniger invasiver Prozeduren für die Behandlung der komplexen Aortenpathologien sowohl im thorakoabdominalen Abschnitt als auch im Aortenbogen. Eine umfassende Behandlung aller Segmente der Aorta mit endovaskulären Techniken wurde noch nicht vollständig evaluiert. Das Ziel dieses Artikels ist die Präsentation eines Überblicks der zurzeit verfügbaren endovaskulären Möglichkeiten der Behandlung von komplexen abdominellen und thorakoabdominellen Aortenaneurysmen, die sowohl eine komplexe thorakale als auch komplexe abdominale Versorgung benötigen.

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Use of a Steerable Sheath for Retrograde Access to Antegrade Branches in Branched Stent-Graft Repair of Complex Aortic Aneurysms

Abstract: Retrograde access for complex aortic endografts with antegrade branches using a steerable sheath appears feasible and effective and may serve as an alternative to upper extremity access.

Cited by 76 publications

References 15 publications

Endovascular Repair Using a 7-Branch Stent-Graft for a Thoracoabdominal Aortic Aneurysm With Variant Renovisceral Artery Anatomy

Endovascular Repair Using a 7-Branch Stent-Graft for a Thoracoabdominal Aortic Aneurysm With Variant Renovisceral Artery Anatomy

Improved stability of steerable sheath access by femoro-femoral crossover wire in branched stent graft repair of complex thoraco-abdominal aortic aneurysms

Aortenaneurysma: fenestrierte/gebranchte abdominale EVAR (fbEVAR) und fenestrierte/gebranchte thorakale EVAR (fbTEVAR). Ist die komplette endovaskuläre Therapie schon da?

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