The "Destino-guided BEVAR" to Catheterize Downward Branches from a Femoral Access: Technical Note and Case Report.
Aortic Dissection
/ diagnostic imaging
Aortic Aneurysm, Thoracic
/ diagnostic imaging
Aortography
/ methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation
/ instrumentation
Catheterization, Peripheral
/ instrumentation
Computed Tomography Angiography
Endovascular Procedures
/ instrumentation
Equipment Design
Female
Femoral Artery
/ diagnostic imaging
Humans
Marfan Syndrome
/ complications
Middle Aged
Punctures
Treatment Outcome
Vascular Access Devices
Journal
Annals of vascular surgery
ISSN: 1615-5947
Titre abrégé: Ann Vasc Surg
Pays: Netherlands
ID NLM: 8703941
Informations de publication
Date de publication:
May 2019
May 2019
Historique:
received:
18
08
2018
revised:
27
09
2018
accepted:
27
09
2018
pubmed:
27
1
2019
medline:
18
6
2019
entrez:
27
1
2019
Statut:
ppublish
Résumé
The aim of this study is to report the Destino-guided branched endovascular aortic repair approach as a valid alternative to catheterization downward branches in complex aortic arch/descending thoracic anatomies. A 53-year-old woman with Marfan syndrome underwent a thoracoabdominal aortic aneurysm (TAAA) repair for a type III dissecting aneurysm. A custom repair with an endograft having 3 fenestrations (for renal arteries and superior mesenteric artery) and 1 branch for the celiac trunk was planned. The right axillary artery was chronically occluded; the left subclavian artery (LSA) was aneurysmatic. The catheterization of the celiac trunk branch was demanding but ultimately a bare stent was used as a bridging component between the graft and the target vessel, for spinal cord preconditioning. At the 2-month computed tomography angiography, when planning the relining of the bare metal stent, a 1 cm increase in diameter of the LSA aneurysm was documented and therefore a Destino-guided branched endovascular aortic repair was planned. This approach consists of branch catheterization via femoral access using the Destino steerable guiding sheath inside which, after bending, a smaller Cook Flexor is placed to easily deliver the stent, while maintaining stability. The Destino-guided branched endovascular aortic repair is a reproducible and effective alternative to the classic catheterization of side branches via brachial/axillary access allowing their completion from a femoral access.
Sections du résumé
BACKGROUND
BACKGROUND
The aim of this study is to report the Destino-guided branched endovascular aortic repair approach as a valid alternative to catheterization downward branches in complex aortic arch/descending thoracic anatomies.
METHODS & RESULTS
RESULTS
A 53-year-old woman with Marfan syndrome underwent a thoracoabdominal aortic aneurysm (TAAA) repair for a type III dissecting aneurysm. A custom repair with an endograft having 3 fenestrations (for renal arteries and superior mesenteric artery) and 1 branch for the celiac trunk was planned. The right axillary artery was chronically occluded; the left subclavian artery (LSA) was aneurysmatic. The catheterization of the celiac trunk branch was demanding but ultimately a bare stent was used as a bridging component between the graft and the target vessel, for spinal cord preconditioning. At the 2-month computed tomography angiography, when planning the relining of the bare metal stent, a 1 cm increase in diameter of the LSA aneurysm was documented and therefore a Destino-guided branched endovascular aortic repair was planned. This approach consists of branch catheterization via femoral access using the Destino steerable guiding sheath inside which, after bending, a smaller Cook Flexor is placed to easily deliver the stent, while maintaining stability.
CONCLUSIONS
CONCLUSIONS
The Destino-guided branched endovascular aortic repair is a reproducible and effective alternative to the classic catheterization of side branches via brachial/axillary access allowing their completion from a femoral access.
Identifiants
pubmed: 30684615
pii: S0890-5096(19)30043-3
doi: 10.1016/j.avsg.2018.09.044
pii:
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
266-271Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.