Impact of System-F in Delivering Vascular Plugs for Aortic Side Branch Embolization During Endovascular Aneurysm Repair

Abstract

Purpose: This study aimed to illustrate the utility of our original system to deliver vascular plugs into aortic side branches during endovascular aneurysm repair (EVAR). Technique: Our device, which we named “System-F,” consists of a 14 Fr sheath, a 12 Fr long sheath with a side hole, a stiff guidewire as a shaft, and a parallelly-inserted delivery catheter navigated through the side hole into the aneurysm sac. Vertical motion and horizontal rotation of the side hole allow multidimensional movement of the delivery catheter within the aneurysm. This system was applied in 7 cases undergoing EVAR; 4 inferior mesenteric arteries and 14 lumbar arteries were embolized using vascular plugs. Type II endoleak (T2EL) was not observed in the follow-up survey of any case. Conclusion: The applicability of System-F for vascular plug placement in the side branches of abdominal aortic aneurysms has the potential to achieve high delivery capability and be widely applied for the prevention of T2EL. Clinical Impact System-F has potential to change the strategies of pre-EVAR embolization.

Plug-Based Embolization Techniques of Aortic Side Branches during Standard and Complex Endovascular Aortic Repair

“…This technique, originally proposed by Morikage et al [31], allows catheter stabilization between the balloon and an introducer sheath while the plug is being released. An evolution of this technique is the so-called "delivery system-F" [57], which consists of a 14 Fr sheath, a 12 Fr long sheath with a side hole, a stiff guidewire as a shaft, and a parallel-inserted delivery catheter navigated through the side hole into the aneurysm sac. The vertical motion and horizontal rotation of the side hole are performed by moving the DrySeal and the 12 Fr sheath, thus securing precision and stability.…”