German Aortic Center, Department of Vascular Medicine, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
J Endovasc Ther. 2020 Dec;27(6):917-921. doi: 10.1177/1526602820939936. Epub 2020 Jul 7.
To describe the use of a steerable sheath from a femoral access for antegrade catheterization of the left common carotid artery (LCCA) in an inner-branched arch endograft. This technique is demonstrated in a patient with residual aortic dissection after replacement of the ascending aorta for acute type A aortic dissection. He presented 4 years later with aneurysmal degeneration of the thoracoabdominal aorta and a proximal tear located in the aortic arch. A 2-stage hybrid approach was devised to treat the patient. An axilloaxillary crossover graft (left to right) with plug occlusion of the innominate artery was performed initially. Later, a dual-branched custom-made device was implanted. To avoid an additional LCCA cutdown for retrograde branch access, an 18-F steerable sheath was used through a percutaneous femoral access. Two wires were delivered within the steerable sheath: the first one was directed into the left subclavian artery to stabilize the sheath position in the ascending aorta; the second wire was used to catheterize the first inner branch and the LCCA to deploy the covered bridging stent. Transfemoral access to catheterize antegrade branches for supra-aortic vessels is feasible using a large steerable sheath in branched endovascular arch repair.
描述一种从股动脉入路使用可操控鞘管对左颈总动脉（LCCA）进行顺行置管的方法，该技术应用于升主动脉置换后急性 A 型主动脉夹层患者的分支型腔内移植物内残余主动脉夹层的治疗。4 年后，该患者出现胸主动脉和腹主动脉夹层瘤样扩张以及位于主动脉弓的近端撕裂。设计了 2 期杂交手术治疗该患者。首先进行腋动脉-腋动脉旁路转流（左侧到右侧）和无名动脉栓堵。然后植入定制的双分支装置。为避免因逆行分支入路而再次进行 LCCA 切开，通过经皮股动脉入路使用 18-F 可操控鞘管。将两根导丝置于可操控鞘管内：第一根导丝进入左锁骨下动脉以稳定鞘管在升主动脉内的位置；第二根导丝用于置管第一内分支和 LCCA 以释放覆盖的桥式支架。在分支型腔内主动脉弓修复中，使用大口径可操控鞘管经股动脉入路顺行置管至升主动脉以实现对超主动脉分支的介入治疗是可行的。
