Marcaccio Christina L, Zettervall Sara L, Wu Winona W, Schermerhorn Marc L, Wyers Mark C
Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Division of Vascular Surgery, University of Washington, Seattle, WA.
Ann Vasc Surg. 2021 Nov;77:338-342. doi: 10.1016/j.avsg.2021.05.030. Epub 2021 Aug 28.
We developed a novel technique using an endovascular snare system to stabilize target vessel cannulation via transfemoral access during fenestrated and branched endovascular aortic aneurysm repair (FBEVAR) in patients with challenging target vessel anatomy. This technique uses a snare, an outer sheath, and an inner delivery sheath to facilitate target vessel cannulation and stenting during FBEVAR. With the outer sheath positioned in the lower end of the partially deployed aortic graft and the delivery sheath within, a large snare is advanced through the outer sheath and over the outside of the delivery sheath until it reaches the curved portion of the delivery sheath at the level of the target vessel. The snare is then tightened to provide stability and maintain proper curvature and alignment of the delivery sheath while the target vessel is selected and stented. Following successful passage, the snare is loosened and removed from the body via the outer sheath. This snare technique is a simple, effective, and inexpensive tool that can be used for difficult target vessel cannulation during FBEVAR.
我们开发了一种新技术，使用血管内圈套系统，在具有挑战性的靶血管解剖结构的患者进行开窗和分支型血管内主动脉瘤修复（FBEVAR）期间，经股动脉入路稳定靶血管插管。该技术使用一个圈套器、一个外鞘和一个内输送鞘，以在FBEVAR期间促进靶血管插管和支架置入。在外鞘位于部分展开的主动脉移植物下端且输送鞘在其内部的情况下，一个大圈套器穿过外鞘并在输送鞘外部推进，直到它到达靶血管水平处输送鞘的弯曲部分。然后收紧圈套器以提供稳定性，并在选择靶血管和置入支架时保持输送鞘的适当曲率和对齐。成功通过后，松开圈套器并通过外鞘从体内取出。这种圈套技术是一种简单、有效且廉价的工具，可用于FBEVAR期间困难的靶血管插管。
