Snare Assisted Steerable Sheath Technique Facilitates Transfemoral Multi-Branched Endografting
Alexander DiBartolomeo, MD, Kenneth R. Ziegler, Gregory A. Magee, MD, Sukgu M. Han, MD.
University of Southern California, Los Angeles, CA, USA.
Branched endografts for complex endovascular aortic repairs typically have caudally directed side arm branch cuffs that allow for antegrade flow to the target vessels. Stents that bridge the branch cuffs to the target vessels are typically placed using upper extremity access for antegrade directed delivery. However, upper extremity access in some complex endovascular aortic repairs may not be feasible due to anatomic constraints and has been associated with higher stroke risks. An alternative approach is to use all transfemoral access for bridging stent delivery, which may make stent delivery difficult due to increased angulations and tortuous paths. The objective of this video is to demonstrate a technique of augmenting sheath stability during transfemoral branch stent delivery.This technique is presented using a case of a 65-year-old man with history of zone 2 thoracic endovascular aortic repair (TEVAR) with subclavian-carotid transposition and an open aortobi-iliac infrarenal aortic repair who presented with a 7 cm thoracoabdominal aortic aneurysm. The patient underwent an all transfemoral TEVAR extension and four-vessel branched endograft placement using a snare-loaded 7 Fr by 55 cm Tourguide steerable sheath for assistance of branch stent delivery. A 10 mm Gooseneck snare is placed around the steerable sheath near the tip and provides tension to stabilize the sheath while long bridging stents are delivered to the target vessels. The advantages of this technique are highlighted in the video.
Back to 2022 ePosters