Single Access and X-Over Reversed Iliac Extension Technique in a PAD Patient Needing Complex Endovascular Aortic Aneurysm Repair.

Autor:	Nana P; German Aortic Center, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany., Kölbel T; German Aortic Center, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany., Panuccio G; German Aortic Center, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany., Torrealba JI; German Aortic Center, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany., Rohlffs F; German Aortic Center, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany.; Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany.
Jazyk:	angličtina
Zdroj:	Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists [J Endovasc Ther] 2024 Jul 26, pp. 15266028241266158. Date of Electronic Publication: 2024 Jul 26.
DOI:	10.1177/15266028241266158
Abstrakt:	Purpose: To describe the X-over reversed iliac extension technique in a patient with severe peripheral arterial disease (PAD) scheduled for inner branched endovascular aortic repair (iBEVAR). Technique: A multimorbid 62-year-old male patient was planned for iBEVAR due to a 58 mm suprarenal aortic aneurysm. The patient had a previous right femoropopliteal bypass and stenting of the left iliac axis. At admission, he presented with recent onset severe left limb claudication, which was attributed to left iliac stent occlusion. To avoid the postoperative compression of the right common femoral artery (CFA) and preserve the patency of the bypass, a single left CFA access, followed by left iliac artery recanalization, was decided. The right iliac axis was catheterized with a Lunderquist wire using X-over access from the left CFA. An iliac extension (ZISL, 24-59, Cook Medical, Bloomington, USA) was reversed and resheathed on back-table and implanted in the right common iliac artery using the X-over technique. The left CFA access was used to complete the remaining steps of the procedure. The predischarge computed tomography angiography confirmed bilateral iliac artery and femoropopliteal bypass patency. Conclusion: The X-over reversed iliac extension technique may be applied in selected PAD patients, when undergoing complex endovascular aortic repair. Clinical Impact: As the number of patients with peripheral arterial disease (PAD) is expected to increase the upcoming decades, out of the box solutions may be needed to assist complex endovascular aortic management. The X over technique, which consist of the contralateral advancement of an on-table reversed iliac limb, was successfully applied in a patient with severe PAD and numerous previous peripheral interventions, who was managed with branched endovascular aortic repair . The X Over technique may provide an additional alternative in well-selected patients with demanding vascular access undergoing complex endovascular aortic procedures. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: TK is a consultant and proctor for and has intellectual property with Cook Medical, receiving royalties, speaking fees, and research, travel, and educational grants. All authors declare no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work; no other relationships or activities that could appear to have influenced the submitted work.
Databáze:	MEDLINE
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