The 'Destino-guided BEVAR' to Catheterize Downward Branches from a Femoral Access: Technical Note and Case Report
| Autor: | Alessia Giaquinta, Matteo Orrico, Nicola Mangialardi, Antonio Lorido, Mario Marino, Fabrizio Nesi, Alessio Vona, Sonia Ronchey, Carlo Setacci |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Bare-metal stent
Aortic arch Computed Tomography Angiography medicine.medical_treatment Thoracic 030204 cardiovascular system & hematology 030218 nuclear medicine & medical imaging Peripheral Marfan Syndrome Aortic aneurysm 0302 clinical medicine Superior mesenteric artery Computed tomography angiography medicine.diagnostic_test Endovascular Procedures General Medicine Equipment Design Middle Aged Aortic Aneurysm Femoral Artery Treatment Outcome cardiovascular system Female Cardiology and Cardiovascular Medicine Vascular Access Devices medicine.medical_specialty Punctures Aortography Catheterization 03 medical and health sciences Blood Vessel Prosthesis Implantation Aneurysm Blood vessel prosthesis medicine.artery Catheterization Peripheral medicine Humans cardiovascular diseases Aneurysm Dissecting Aortic Aneurysm Thoracic Blood Vessel Prosthesis business.industry Stent medicine.disease Surgery Aortic Dissection business Dissecting |
| Popis: | Background The aim of this study is to report the Destino-guided branched endovascular aortic repair approach as a valid alternative to catheterization downward branches in complex aortic arch/descending thoracic anatomies. Methods & Results A 53-year-old woman with Marfan syndrome underwent a thoracoabdominal aortic aneurysm (TAAA) repair for a type III dissecting aneurysm. A custom repair with an endograft having 3 fenestrations (for renal arteries and superior mesenteric artery) and 1 branch for the celiac trunk was planned. The right axillary artery was chronically occluded; the left subclavian artery (LSA) was aneurysmatic. The catheterization of the celiac trunk branch was demanding but ultimately a bare stent was used as a bridging component between the graft and the target vessel, for spinal cord preconditioning. At the 2-month computed tomography angiography, when planning the relining of the bare metal stent, a 1 cm increase in diameter of the LSA aneurysm was documented and therefore a Destino-guided branched endovascular aortic repair was planned. This approach consists of branch catheterization via femoral access using the Destino steerable guiding sheath inside which, after bending, a smaller Cook Flexor is placed to easily deliver the stent, while maintaining stability. Conclusions The Destino-guided branched endovascular aortic repair is a reproducible and effective alternative to the classic catheterization of side branches via brachial/axillary access allowing their completion from a femoral access. |
| Databáze: | OpenAIRE |
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