Grandi Alessandro, Gronert Catharina, Panuccio Giuseppe, Rohlffs Fiona, Yousef Al Sarhan Daour, Kölbel Tilo
German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Endovasc Ther. 2025 Aug;32(4):979-988. doi: 10.1177/15266028231197972. Epub 2023 Sep 9.
To describe the technique of transvenous access for emergent endovascular repair of thoracic and thoracoabdominal aneurysms exemplified with 2 cases.
Transvenous access to the aorta is described as an alternative access method to deliver aortic endografts in emergency situations. A 68-year-old female patient with severely compromised iliac and subclavian artery access was treated for a ruptured extent V thoraco-abdominal aortic aneurysm with a t-Branch (Cook Medical, Bjaeverskov, Denmark) delivered through a transcaval access. To avoid severe aortocaval shunting a balloon-expandable covered stent was deployed through a carotid access due to severe bilateral subclavian ostial stenosis. A 71-year-old man with an acute type B aortic dissection and bilateral narrow long-segment stenting of the iliac arteries was treated with a physician-modified thoracic endovascular aortic repair using an arteriovenous fenestration created at the level of the common iliac artery. We describe the access creation by fenestration using a transseptal needle.
Transvenous access for thoracic and thoraco-abdominal aortic aneurysm repair is safe and feasible in selected emergent cases.Clinical ImpactA transvenous approach may be helpful in selected patients when an endovascular repair needs to be performed but no arterial femoral access is available. This approach proved to be feasible even with large-bore introducer sheaths, taking its place in the armamentarium of the vascular surgeon for emergent complex endovascular aortic repairs.
通过2例病例说明经静脉途径用于胸主动脉和胸腹主动脉瘤急诊血管腔内修复的技术。
经静脉进入主动脉被描述为在紧急情况下输送主动脉内移植物的一种替代入路方法。一名68岁女性患者，髂动脉和锁骨下动脉严重受损，通过经腔静脉途径置入t型分支（库克医疗公司，丹麦比耶沃斯科夫）治疗破裂的Ⅴ型胸腹主动脉瘤。由于严重的双侧锁骨下动脉开口狭窄，为避免严重的主动脉腔静脉分流，通过颈动脉途径置入球囊扩张式覆膜支架。一名71岁男性，患有急性B型主动脉夹层，双侧髂动脉狭窄且长段支架置入，采用医生改良的胸主动脉腔内修复术，在髂总动脉水平创建动静脉开窗。我们描述了使用经间隔穿刺针进行开窗的入路创建方法。
在特定的急诊病例中，经静脉途径用于胸主动脉和胸腹主动脉瘤修复是安全可行的。
临床影响
当需要进行血管腔内修复但无法获得股动脉入路时，经静脉途径对特定患者可能有帮助。即使使用大口径导入鞘，这种方法也被证明是可行的，它在血管外科医生用于急诊复杂胸主动脉腔内修复的手段中占有一席之地。
