Sequential Catheterization and Progressive Deployment of the Zenith® t-Branch™ Device for Branched Endovascular Aortic Aneurysm Repair

Malekpour, Fatemeh; Scott, Carla K.; Kirkwood, Melissa L.; Timaran, Carlos H.

doi:10.1007/s00270-020-02654-8

Cited by 17 publications

(4 citation statements)

References 16 publications

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“…These branches traditionally require an axillary or brachial arterial approach for catheterization from above [ 8 – 10 ]. Apart from offering a better sealing between the main body and stentgraft inside the aneurysm, branches also offer more variability to catheterize the visceral arteries, which has led to the introduction of off-the-shelf devices suitable for the majority of patient anatomies [ 11 , 12 ].…”

Section: Introductionmentioning

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

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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.

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Section: Introductionmentioning

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

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“…The partial endograft deployment technique, initially introduced for outer-branched devices concurrently in two separate papers by Simonte et al and Malekpour et al in January 2021, has rapidly gained popularity and is now widely embraced across numerous centers [ 1 , 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Partial endograft deployment has been described when using outer-branched endografts in narrow aortic lumina. By keeping the distal portion of the device constrained inside its delivery system, it is possible to increase the available intra-aortic space to properly cannulate and bridge visceral vessels in the critical aortic segment located at the level of target artery ostia [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

Partial Deployment to Save Space for Vessel Cannulation When Treating Complex Aortic Aneurysms with Narrow Paravisceral Lumen Is Also Feasible Using Inner-Branched Pre-Cannulated Endografts

Simonte,

Gatta,

Vento

et al. 2024

JCM

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Introduction: The aim of this paper is to propose a sequential deployment technique for the E-nside off-the-shelf endograft that could potentially enhance target visceral vessel (TVV) cannulation and overstenting in narrow aortic anatomies. Methods: All data regarding patients consecutively treated in two aortic centers with the E-nside graft employing the partial deployment technique were included in the study cohort and analyzed. To execute the procedure with partial endograft deployment, the device should be prepared before insertion by advancing, under fluoroscopy, all four dedicated 400 cm long 0.018″ non-hydrophilic guidewires until their proximal ends reach the cranial graft’s edge. Anticipating this guidewire placement prevents the inability to do so once the endograft is partially released, avoiding potentially increased friction inside the constricted pre-loaded microchannels. The endograft is then advanced and deployed in the standard fashion, stopping just after the inner branch outlets are fully expanded. Tip capture is released, and the proximal end of the device is opened. Visceral vessel bridging is completed from an upper access in the desired sequence, and the graft is fully released after revascularizing one or more arteries. Preventing the distal edge of the graft from fully expanding improves visceral vessel cannulation and bridging component advancement, especially when dealing with restricted lumina. Results: A total of 26 patients were treated during the period December 2019–March 2024 with the described approach. Procedure was performed in urgent settings in 14/26 cases. The available lumen was narrower than 24 mm at the origin of at least one target vessel in 11 out of 26 cases performed (42.3%). Technical success was obtained in 24 out of 26 cases (92.3%), with failures being due to TVVs loss. No intraoperative death or surgical conversion was recorded, and no early reintervention was needed in the perioperative period. Clinical success at 30 days was therefore 80.7%. Conclusions: The described technique could be considered effective in saving space outside of the graft, allowing for safe navigation and target vessel cannulation in narrow visceral aortas, similar to what has already been reported for outer-branched endografts.

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“…In their study, Malekpour et al describe a novel technique of sequential catheterization and stenting amid progressive deployment (SCAPED) for the t-Branch device [2]. In brief, the t-Branch is deployed only enough to release the proximal target vessel (TV) cuff, with the remaining branches and the distal edge remaining constrained within the delivery sheath while the TV is selected and accessed.…”

mentioning

confidence: 99%

New Technical Approach to Overcome Anatomical Challenges During Branched Endovascular Aortic Repair with off-the-Shelf Multibranched Stent-Grafts: Are We Sequentially and Progressively Scraping the Sky?

D’Oria

Lepidi

2020

Cardiovasc Intervent Radiol

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Sequential Catheterization and Progressive Deployment of the Zenith® t-Branch™ Device for Branched Endovascular Aortic Aneurysm Repair

Cited by 17 publications

References 16 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

Partial Deployment to Save Space for Vessel Cannulation When Treating Complex Aortic Aneurysms with Narrow Paravisceral Lumen Is Also Feasible Using Inner-Branched Pre-Cannulated Endografts

New Technical Approach to Overcome Anatomical Challenges During Branched Endovascular Aortic Repair with off-the-Shelf Multibranched Stent-Grafts: Are We Sequentially and Progressively Scraping the Sky?

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