1 Department of Surgery, Division of Vascular Surgery, University of California Davis, Sacramento, CA, USA.
2 Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.
J Endovasc Ther. 2018 Feb;25(1):21-27. doi: 10.1177/1526602817747283. Epub 2018 Jan 9.
To describe a modified up-and-over access technique for treatment of iliac artery aneurysms in patients with prior bifurcated stent-grafts for endovascular aneurysm repair (EVAR).
This technique uses a coaxial 12-F flexible sheath that is docked with a through-and-through wire into a 7-F sheath advanced from the contralateral femoral approach. This maneuver allows both sheaths to be moved as a unit while maintaining position of the apex of the system as it loops over the flow divider, avoiding damage to or displacing the extant endograft. Once the 12-F sheath is positioned in the iliac limb of the aortic stent-graft and secured in place with the through-and-through wire, the repair is extended into the internal iliac artery using a bridging stent-graft or covered stent introduced via a coaxial sheath.
The up-and-over technique with a flexible 12-F sheath mated with a 7-F sheath from the opposite side allows bilateral femoral access to be used for iliac branch device placement after prior aortic endograft procedures that create a higher, acutely angled bifurcation. Use of a through-and-through wire and a coaxial sheath for stent delivery creates a very stable platform for intervention.
描述一种改良的翻越技术，用于治疗既往行分叉支架型腔内动脉瘤修复术（EVAR）的患者的髂动脉动脉瘤。
该技术使用同轴的 12-F 柔性鞘管，通过贯穿导丝与从对侧股动脉入路推进的 7-F 鞘管对接。这种操作可以使两个鞘管作为一个单元移动，同时保持系统尖端的位置，因为它在血流分隔器上绕圈，避免对现有的内支架移植物造成损伤或移位。一旦 12-F 鞘管定位在主动脉支架型腔内的髂支并通过贯穿导丝固定到位，就可以通过同轴鞘管引入桥接支架型或覆膜支架将修复扩展到髂内动脉。
带有柔性 12-F 鞘管的翻越技术与来自对侧的 7-F 鞘管配合使用，允许在既往的主动脉内支架移植物手术后使用双侧股动脉入路进行髂支装置放置，这些手术会导致更高、锐角的分叉。使用贯穿导丝和同轴鞘管进行支架输送为介入治疗创建了一个非常稳定的平台。
