Clinic for Cardiovascular Surgery, Zurich University Hospital, Zurich, Switzerland.
J Endovasc Ther. 2013 Aug;20(4):492-7. doi: 10.1583/13-4311.1.
To present a technique for transfemoral implantation of parallel grafts into the renal arteries in patients with anatomy or morphology that blocks standard antegrade chimney graft delivery.
In a totally percutaneous approach, a 5-F pigtail angiographic catheter is passed into the aorta above the renal arteries via a 0.035-inch hydrophilic guidewire, followed by an 8-F sheath. The target vessel is cannulated with the hydrophilic wire followed by a 5-F reverse curve catheter; the wire is changed for a Rosen wire. The main stent-graft body is delivered and parked at the level of the aortic bifurcation. The Viabahn chimney endograft is advanced ~1 to 2 cm into the target renal artery and deployed such that its proximal end faces downward; its distal end is fixed in place with an inflated angioplasty balloon. A stiff guidewire is inserted coaxially through the 8-F sheath, the Rosen guidewire is removed, and the 8-F sheath is carefully pushed over the stiff guidewire, lifting the sheath and chimney endograft upward. With the chimney reoriented cranially, the aortic stent-graft is deployed immediately. The abdominal stent-graft and the chimney graft(s) are molded synchronously using kissing balloons.
Transfemoral placement of chimney covered stents by the lift technique in cases of unsuccessful or hazardous catheterization of the target vessels via the upper extremity is safe and feasible in centers experienced with the standard chimney technique.
介绍一种技术，用于将平行移植物经股动脉植入肾动脉，适用于解剖结构或形态阻碍标准顺行烟囱移植术的患者。
在完全经皮入路中，通过 0.035 英寸亲水导丝将 5-F 猪尾造影导管置于主动脉肾动脉上方，然后置入 8-F 鞘。用亲水导丝对目标血管进行穿刺，然后置入 5-F 反弯导管；将导丝更换为 Rosen 导丝。将主支架移植物体输送并停留在主动脉分叉处。将 Viabahn 烟囱支架移植物推进至目标肾动脉约 1 至 2cm 并展开，使其近端朝下；用充气球囊固定其远端。同轴插入一根硬导丝穿过 8-F 鞘，取出 Rosen 导丝，小心地将 8-F 鞘推过硬导丝，将鞘和烟囱支架向上提起。将烟囱重新定向至颅侧，立即展开主动脉支架移植物。使用吻球囊对腹主动脉支架和烟囱移植物（多个）进行同步塑形。
在经验丰富的标准烟囱技术中心，对于通过上肢无法成功或危险地对目标血管进行导管插入的病例，经股动脉放置烟囱覆盖支架的提升技术是安全且可行的。
