Preloaded Catheters and Guide-Wire Systems to Facilitate Catheterization During Fenestrated and Branched Endovascular Aortic Repair

Chini, Julia; Mendes, Bernardo C.; Tenorio, Emanuel R.; Ribeiro, Maurício Serra; Sandri, Giuliano A.; Cha, Stephen; Hofer, Jan; Oderich, Gustavo S.

doi:10.1007/s00270-019-02322-6

Cited by 26 publications

(15 citation statements)

References 18 publications

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“…Techniques of fenestrated/branched endovascular aneurysm repair (f/bEVAR) for complex aortic lesions continue to evolve after the development of preloaded guidewire systems and lower-profile technology. [1][2][3][4][5][6][7] Although most of these procedures can be successfully performed using transfemoral access, an upper extremity approach has been used to facilitate catheterization of caudally oriented vessels, particularly the superior mesenteric and celiac arteries. Steerable sheaths have improved catheterization via the femoral approach and decreased utilization of upper extremity access in many centers.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Cerebral Embolic Events Between Right and Left Upper Extremity Access During Fenestrated/Branched Endovascular Aortic Repair

et al. 2020

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Purpose: To evaluate the incidence and outcomes of cerebral embolic events when using right (RUE) vs left upper extremity (LUE) access for fenestrated/branched endovascular aneurysm repair (f/bEVAR). Materials and Methods: A retrospective review was conducted of 290 consecutive patients enrolled in a physician-sponsored Investigational Device Exemption study to evaluate f/bEVAR between 2013 and 2018. Of these, 270 patients (93%) had an upper extremity access with 12-F sheaths, including 205 patients (mean age 75±8 years; 147 men) with LUE and 65 patients (mean age 73±8 years; 42 men) with RUE access. Outcome measures were technical success, procedural metrics, major adverse events (MAEs), any stroke or transient ischemic attack (TIA), and mortality. Results: Technical success was higher (p=0.04) for LUE (99.6%) vs RUE access (98.4%). Patients treated via RUE access more often had extent I-III thoracoabdominal aortic aneurysms (57% vs 39%, p=0.03). Procedural metrics were similar for LUE vs RUE sides, including endovascular time (255±80 vs 246±83 minutes, respectively; p=0.23), fluoroscopy time (84±32 vs 90±35 minutes, respectively; p=0.80), and contrast volume (156±57 vs 153±56 mL, respectively; p=0.82). Total radiation exposure was significantly higher for LUE vs RUE access (2463±1912 vs 1757±1494 mGy, respectively; p=0.02). There were 2 deaths (1%) at 30 days or during hospital admission, both unrelated to access site complications. MAEs occurred in 32% of patients who had LUE and 26% of those who had RUE access (p=0.44). Five patients (2%) had embolic stroke and none had TIA. Embolic strokes were ipsilateral to the access side in 4 patients and affected the posterior circulation in 3. Two patients (1%) had hemorrhagic strokes. The incidence of stroke was 3% for LUE and 2% for RUE access (p>0.99). Conclusion: Fenestrated/branched stent-graft repair was associated with low rates of cerebral embolic events and no significant difference between the right vs left upper extremity approach.

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Section: Introductionmentioning

confidence: 99%

Comparison of Cerebral Embolic Events Between Right and Left Upper Extremity Access During Fenestrated/Branched Endovascular Aortic Repair

et al. 2020

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“…However, the major drawback of this access, independently of the level (brachial/axillary) or side (right vs left), has been a stroke risk of 2% to 4%. [1][2][3] Further complication risks of UEA include median nerve neuropraxia in w1% and secondary hematoma in 0.5% of patients. 1 Recently, an alternative retrograde approach using transfemoral access (TFA) and steerable sheaths was proposed to reduce the risk of these UEA-related complications.…”

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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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“…Mayo Clinic applied auxiliary preloaded guidewires to treat TAAA on 83 patients with TAAA or pararenal aortic aneurysm. The technical success rate was 99.7% on average operation time of 160 min, 30-day mortality was recorded as 0% [30]. The result revealed that this technique could facilitate visceral branched arterial reconstruction and reduce the difficulty of operation.…”

Section: Fig 3 Knickbocker Techniquementioning

confidence: 83%

Endovascular strategies for post-dissection aortic aneurysm (PDAA)

Zeng

Zhao

et al. 2020

J Cardiothorac Surg

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Residual patent false lumen (FL) after type B aortic dissection (TBAD) repair is independently associated with poor long-term survival. Open surgery and endovascular repair result in good clinical outcomes in patients with AD. However, both treatments focus on proximal dissection but not distal dissection. About 13.4–62.5% of these patients present with different degrees of distal aneurysmal dilatation after primary repair. Although open surgery is the first-choice treatment for post-dissection aortic aneurysm (PDAA), there is a need for high technical demand since open surgery is associated with high mortality and morbidity. As a treatment strategy with minimal invasion, endovascular repair shows early benefits and low morbidity. For PDAA, the narrow true lumen (TL), rigid initial flap and branch arteries originating from FL have increased difficulties in operation. The aim of endovascular treatment is to promote FL thrombosis and aortic remodeling. Endovascular repair includes intervention from FL and TL sides. TL intervention techniques (parallel stent-graft, branched and fenestrated stent-graft among others) have been proven to be safe and effective in PDAA. Other FL intervention techniques that have been used in selected patients include FL embolization and candy-plug techniques. This article introduces available endovascular techniques and their outcomes for the treatment of PDAA.

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Preloaded Catheters and Guide-Wire Systems to Facilitate Catheterization During Fenestrated and Branched Endovascular Aortic Repair

Cited by 26 publications

References 18 publications

Comparison of Cerebral Embolic Events Between Right and Left Upper Extremity Access During Fenestrated/Branched Endovascular Aortic Repair

Comparison of Cerebral Embolic Events Between Right and Left Upper Extremity Access During Fenestrated/Branched Endovascular Aortic Repair

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

Endovascular strategies for post-dissection aortic aneurysm (PDAA)

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