Schulte Katrin, Zdoroveac Andrei, Gürke Lorenz, Isaak Andrej
Vascular and Endovascular Surgery, Cantonal Hospital Aarau, Aarau, Switzerland.
Vascular and Endovascular Surgery, University Hospital Basel, Aarau, Switzerland.
Catheter Cardiovasc Interv. 2023 Dec;102(7):1271-1274. doi: 10.1002/ccd.30840. Epub 2023 Sep 11.
Cannulation and placement of the contralateral stent graft limb during endovascular aortic repair (EVAR) procedure are crucial steps as mispositioning may lead to conversion to open aortic repair. Endovascular bail-out strategies for stent graft relocation in EVAR are underreported though detailed knowledge may facilitate application and prevent conversion. We present three endovascular bail-out strategies for repositioning of a mispositioned contralateral stent graft limb. (1) Retraction of the mispositioned component with an inflated reliant balloon and placement of an interposition stent graft after successful cannulation; (2) Push-maneuver of the mispositioned stent graft into the infrarenal aortic aneurysm with an inflated reliant balloon supported by a large lumen introducer sheath and (3) Parallel placement of a second contralateral stent graft limb displacing the mispositioned one against the atrial wall in cases with adequate vessel diameter. Prevention of stent graft mispositioning by applying recognized tests to ensure correct placement are essential, following the slogan: check twice, deploy once.
在血管腔内主动脉修复术（EVAR）过程中，对侧支架移植物肢体的插管和放置是关键步骤，因为位置错误可能导致转为开放性主动脉修复术。尽管详细了解血管腔内主动脉修复术中支架移植物重新定位的血管腔内补救策略可能有助于其应用并防止转为开放性手术，但相关报道较少。我们介绍三种血管腔内补救策略，用于重新定位位置错误的对侧支架移植物肢体。（1）使用充盈的依赖球囊回缩位置错误的组件，并在成功插管后放置插入式支架移植物；（2）在大腔导入鞘管支撑的充盈依赖球囊辅助下，将位置错误的支架移植物推送至肾下主动脉瘤内；（3）在血管直径足够的情况下，平行放置第二个对侧支架移植物肢体，将位置错误的肢体压向血管壁。遵循“检查两遍，放置一次”的口号，通过应用公认的测试来确保正确放置，以防止支架移植物位置错误至关重要。
