Use of a Steerable Sheath for Antegrade Catheterization of a Supra-aortic Branch of an Inner-Branched Arch Endograft via a Percutaneous Femoral Access

Settembrini, Alberto M.; Kölbel, Tilo; Rohlffs, Fiona; Eleshra, Ahmed; Debus, Eike Sebastian; Panuccio, Giuseppe

doi:10.1177/1526602820939936

Cited by 17 publications

(8 citation statements)

References 15 publications

(20 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other examples of transfemoral bEVAR approach have been reported, among them a series of heterogeneous approaches of physician-modified sheath-in-sheath combinations with wires [ 14 ] and two case reports: one describing a successful implantation with the sheath reported here [ 21 ] and one using another commercially available steerable sheath (Destino, Oscor, Palm Harbor, USA) [ 17 ].…”

Section: Discussionmentioning

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

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

View full text Add to dashboard Cite

show abstract

“…Of the 15 patients with 1-year follow-up, 7 decreased the aneurysm size with a median (interquartile range) of decrease of 10 6-12 mm. The rest of the patients presented a stable size.…”

Section: Resultsmentioning

confidence: 99%

“…When using a stent-graft with 2 inner branches, a LCSBP is usually performed in a staged procedure, and the innominate artery (IA) and LCCA are used as target vessels for the 2 inner branches. For an endograft with 3 inner branches, exposure of the LCCA for retrograde branch-access or utilization of a steerable sheath to cannulate the LCCA 12 with retrograde catheterization of the left subclavian artery (LSA) is performed. Alternatively bilateral carotid artery cutdown can be performed.…”

Section: Methodsmentioning

confidence: 99%

Non-Standard Management of Target Vessels With the Inner Branch Arch Endograft: A Single-Center Retrospective Study

Torrealba

Σπανός

Panuccio³

et al. 2021

J Endovasc Ther

Self Cite

View full text Add to dashboard Cite

Purpose: The purpose of this study was to evaluate early and mid-term results of non-standard management of the supraaortic target vessels with the use of the inner branch arch endograft in a single high-volume center. Material and methods: A single-center retrospective study including all patients undergoing implantation of an inner branch arch endograft from December 2012 to March 2021, who presented a non-standard management of the supraaortic target vessels (any bypass other than a left carotid-subclavian or landing in a dissected target vessel). Technical success, mortality, reinterventions, endoleak (EL), and aortic remodeling at follow-up were analyzed. Results: Twenty-four patients were included. In 17 (71%) cases, the non-standard management was related to innominate artery (IA) compromise (12 with IA dissection, 2 with short IA, 2 with short proximal aortic landing zone that required occlusion of IA, 1 with occluded IA after open arch repair). Two (8%) cases were related to an aberrant right subclavian artery (RSA), 1 patient (4%) due to the concomitant presence of a left vertebral artery (LVA) arising from the arch and an occluded left subclavian artery (LSA), and another patient presented with an occluded LSA distal to a dominant vertebral artery. Three (13%) cases were exclusively related to management in patients with genetic aortic syndromes. Twenty (83%) patients had a previous type A aortic dissection. Ten (42%) patients presented a thoracic or thoracoabdominal aortic aneurysm and 8 (33%) patients an arch aneurysm, 6 of them associated to false lumen (FL) perfusion. There were 2 (8%) perioperative minor strokes, and 1 patient with perioperative mortality. Seven patients presented an early type I endoleak, all resolved at follow-up. Seven patients required reinterventions during follow-up (7 reinterventions related to continuous false lumen perfusion, 3 related to Type Ia endoleak, 2 related to surgical bypass). All patients who presented with FL perfusion had complete FL thrombosis at follow-up. No patient presented aneurysm growth at follow-up. Conclusions: The use of the inner branch arch endograft with a non-standard management of the supraaortic target vessels is a possible option. Despite a high reintervention rate, regression or stability of the aneurysmal diameter was achieved in all the patients with follow-up.

show abstract

“…We have found this technique simpler than using steerable sheaths. 7 Those available to us have not been helpful when used with arch branch grafts-they are either too stiff or too cumbersome in the endograft lumen, or simply too short.…”

Section: Bct Bridging Stentmentioning

confidence: 99%

“First in Man” Total Percutaneous Aortic Arch Repair With 3-Inner-branch Endografts

et al. 2021

View full text Add to dashboard Cite

Background Data: Aneurysms of the arch are a complex clinical problem and a technical challenge. Currently, over 40% of patients are considered unfit for conventional open surgery, requiring a cardiopulmonary bypass and hypothermic circulatory arrest. In experienced hands and appropriate anatomic conditions, arch-branched graft technology has shown to be a safe and effective alternative to open conventional surgery to patients that historically have had no surgical options. Objectives: This report summarizes the first in man implant of a three-vessel arch branch stent graft using a total percutaneous approach without the need for exposure of the cervical arteries-a surgical step with inherent problems and risks. Methods: This approach was performed in two consecutive patients, a 66year-old woman with a chronic post type A dissection 60 mm diameter aneurysm of the aortic arch, and a 72-year-old man with a 70 mm saccular degenerative atheromatous aortic arch aneurysm. Results: Technical success was obtained in both cases. The patients were extubated in the operating theatre. Neither suffered any pre-or postoperative neurological deficits. Both were discharged home after remarkably uneventful hospital stays. There were no access complications. Postoperative computerized tomography scans and ultra-sound confirmed patent supra-aortic branches and completely excluded aneurysms. Conclusions: Our new truly minimally invasive approach demonstrates that it is possible to manage one of the most challenging treatments of aortic pathologies without any surgical incision. Further, evaluation and experience are required to confirm these promising results.

show abstract

Use of a Steerable Sheath for Antegrade Catheterization of a Supra-aortic Branch of an Inner-Branched Arch Endograft via a Percutaneous Femoral Access

Cited by 17 publications

References 15 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

Non-Standard Management of Target Vessels With the Inner Branch Arch Endograft: A Single-Center Retrospective Study

“First in Man” Total Percutaneous Aortic Arch Repair With 3-Inner-branch Endografts

Contact Info

Product

Resources

About