Re: “Snare-Ride: A Bailout Technique to Catheterize Target Vessels With Unfriendly Anatomy in Branched Endovascular Aortic Repair”

Ysa, August; Mikelarena, Ederi

doi:10.1177/1526602817728077

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“…Some concerns have also been raised because a bulky device may be more prone to induce plaque lifting, especially when dealing with small renal arteries or diseased vessels. 7 Stabilizing snaring sheaths have been described to facilitate crossover iliac artery embolization procedures 8 but not for BEVAR. The technique used by our institution is based on a standard "through-and-through" technique and does not modify the modus operandi for conventional branch placement; it only provides additional stability for catheterization and bridging stent placement and can be performed in any downward-directed branches (Figure 3a-d) including inner branches.…”

Section: Discussionmentioning

confidence: 99%

Stabilizing Technique for Bridging Stent Placement in Branched Endovascular Aortic Repair

et al. 2021

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Purpose To present a bailout technique for bridging covered stent placement during branched endovascular aortic repair (BEVAR) in complex anatomy. Technique BEVAR is an alternative technique for the treatment of thoracoabdominal aortic aneurysms (TAAAs). Visceral and renal vessels must be preserved by bridging covered stent placement through downward-oriented branches of the main stent graft device. Challenging anatomy such as kinking and elongation of the aorta, or type III aortic arch configuration may impede successful catheterization of these branches due to reduced steerability and pushability of the endovascular material. Different alternative techniques have been described to overcome these anatomic barriers. This technical note adds another endovascular solution to complex cases using the guiding sheath stabilizing technique. It is based on a standard “through-and-through” technique. An attached snare is inserted via femoral approach, providing a stable position for branch catheterization and bridging covered stent deployment. Conclusion The stabilizing technique is safe and easy to perform and provides a stable position of the guiding sheath when antegrade branch catheterization is challenging. This technique is an additional tool for handling challenging cases.

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Section: Discussionmentioning

confidence: 99%