Lerisson Erol, Le Houérou Thomas, Rockley Mark, Gaudin Antoine, Costanzo Alessandro, Fabre Dominique, Haulon Stéphan
Aortic Center, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint-Joseph, Paris Saclay University, Paris, France.
J Endovasc Ther. 2025 Aug;32(4):969-973. doi: 10.1177/15266028231198219. Epub 2023 Sep 7.
The purpose of the study is to describe a new bailout maneuver for use during branched endovascular thoracoabdominal aneurysm repair (BEVAR) while dealing with challenging target vessel cannulation.
A 54-year-old woman underwent urgent BEVAR with a low-profile T-branch device to exclude a type 2 thoracoabdominal aneurysm (TAAA). The endovascular procedure was challenging because the left renal artery ostium was covered by the endograft fabric, compounded by diseased target vessels. A novel bailout maneuver is described. After angioplasty of the left renal artery (LRA), the LRA remained precannulated and a low-profile T-branch was implanted. The 3 proximal branches (superior mesenteric artery, inferior mesenteric artery, and the right renal artery) were connected to their respective target vessels swiftly with a steerable sheath from a femoral approach. Access to the left renal artery was not achieved because it was obstructed by the fully deployed endograft. We subsequently stented the LRA over the "pre-positioned buddy wire," using a balloon-expandable covered stent protruding inside the aneurysm lumen. The proximal stent was then flared and lifted upward using an 8.5 Fr steerable sheath, which made cannulation and stenting of the LRA through the side-branch from above finally achievable.
The elevator technique described in this article will help achieve technical success in challenging BEVAR cases.Clinical ImpactWe describe in this technical note the "elevator technique" that will complement the "Snare-Ride" and "Balloon Anchoring" techniques over a buddy wire positioned in a target vessel, to provide successful bailout options for challenging TV cannulations during BEVAR.After failed access to the renal artery through the renal branch, a covered stent was implanted in the renal artery over the buddy wire with 10 mm protruding into the aortic lumen. This stent was then flared, prior to advancing a curved steerable sheath into the stent, which shaped it with a superior-facing funneled aortic segment. This maneuver resulted in the renal stent facing its corresponding branch, finally easy to access from the endograft lumen.
本研究的目的是描述一种在分支型血管腔内胸腹主动脉瘤修复术（BEVAR）中处理具有挑战性的目标血管插管时使用的新补救策略。
一名54岁女性接受了使用低轮廓T型分支装置的紧急BEVAR，以排除2型胸腹主动脉瘤（TAAA）。血管腔内手术具有挑战性，因为左肾动脉开口被移植物织物覆盖，且目标血管存在病变。描述了一种新颖的补救策略。在对左肾动脉（LRA）进行血管成形术后，LRA仍处于预先插管状态，然后植入了一个低轮廓T型分支。通过股动脉途径使用可操纵鞘管将3个近端分支（肠系膜上动脉、肠系膜下动脉和右肾动脉）迅速连接到各自的目标血管。由于完全展开的移植物阻塞，未能成功进入左肾动脉。随后，我们使用一个球囊可扩张带膜支架在“预先放置的伙伴导丝”上对LRA进行支架置入，该支架突出于动脉瘤腔内。然后使用一个8.5 Fr可操纵鞘管将近端支架扩口并向上提起，这最终使得通过上方的侧支对LRA进行插管和支架置入成为可能。
本文所述的提升技术将有助于在具有挑战性的BEVAR病例中取得技术成功。
我们在本技术说明中描述了“提升技术”，该技术将在位于目标血管中的伙伴导丝上补充“圈套骑行”和“球囊锚定”技术，为BEVAR期间具有挑战性的目标血管插管提供成功的补救选择。在通过肾分支未能成功进入肾动脉后，在伙伴导丝上于肾动脉中植入一个带膜支架，使其有10 mm突出到主动脉腔内。然后在将一个弯曲的可操纵鞘管推进到支架之前对该支架进行扩口，使其形成一个朝上的漏斗状主动脉段。这一操作使得肾支架朝向其相应分支，最终易于从移植物腔内进入。
