Orrico Matteo, Ronchey Sonia, Setacci Carlo, Marino Mario, Vona Alessio, Lorido Antonio, Nesi Fabrizio, Giaquinta Alessia, Mangialardi Nicola
Department of Vascular Surgery, San Camillo-Forlanini Hospital, Rome, Italy.
Department of Vascular Surgery, San Camillo-Forlanini Hospital, Rome, Italy.
Ann Vasc Surg. 2019 May;57:266-271. doi: 10.1016/j.avsg.2018.09.044. Epub 2019 Jan 24.
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.
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.
本研究的目的是报告在复杂主动脉弓/降主动脉解剖结构中，Destino引导下的分支型血管腔内主动脉修复方法可作为向下分支导管插入术的有效替代方案。
一名53岁患有马凡综合征的女性因III型夹层动脉瘤接受胸腹主动脉瘤（TAAA）修复术。计划采用定制的带3个开窗（用于肾动脉和肠系膜上动脉）和1个腹腔干分支的血管内移植物进行修复。右腋动脉长期闭塞；左锁骨下动脉（LSA）呈瘤样扩张。腹腔干分支的导管插入术具有挑战性，但最终使用裸支架作为移植物与目标血管之间的桥接部件，用于脊髓预处理。在术后2个月的计算机断层扫描血管造影检查中，计划对裸金属支架进行内衬时，发现LSA动脉瘤直径增大了1 cm，因此计划采用Destino引导下的分支型血管腔内主动脉修复术。该方法包括通过股动脉入路使用Destino可转向引导鞘进行分支导管插入，在鞘管弯曲后，放入较小的Cook Flexor以便轻松输送支架，同时保持稳定性。
Destino引导下的分支型血管腔内主动脉修复术是一种可重复且有效的替代方法，可替代通过肱动脉/腋动脉入路对侧支进行的传统导管插入术，从而能够通过股动脉入路完成手术。
