The Retrograde-Access Gutter Snare (RAGS) Technique: A Bailout Maneuver to Maintain Patency of the Left Subclavian Artery in Fenestrated TEVAR.

IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE
John H Landau, Luc A Dubois, Adam H Power
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引用次数: 0

Abstract

Purpose: The purpose of this study is to describe a new bailout maneuver for use during fenestrated thoracic endovascular aneurysm repair (fTEVAR) in the event of wire wrap or wire entanglement with the proximal graft fabric.

Technique: A 68-year-old-man with hypertension and chronic atrial fibrillation underwent elective thoracic endovascular aneurysm repair (TEVAR) with a left subclavian fenestration to treat a residual arch and thoracic aortic aneurysm after previous type A dissection repair. The procedure was challenging due to malrotation of the main body graft, as well as wire entanglement of the precannulated through-and-through wire on the leading edge of the main body fabric. A novel bailout maneuver is described. Through-and-through access was maintained, and a long 8F sheath was delivered through the fenestration from femoral access, and an 8.5F steerable sheath was delivered through upper extremity access. This allowed coaxial snaring of a new through-and-through wire via the gutter between the stent-graft and native aorta in the seal zone, which both reoriented the fenestration, and permitted placement of a bridging stent to the left subclavian artery.

Conclusion: The retrograde-access gutter snare (RAGS) technique described above provides a streamlined approach to achieve technical success in challenging fenestrated thoracic endovascular aneurysm repair (fTEVAR) cases.

Clinical impact: This technical note describes the retrograde-access gutter snare (RAGS) technique that can provide a successful bailout maneuver for fenestrated TEVAR (fTEVAR) devices. The RAGS technique offers an approach to be used with precannulated custom-made or physician-modified fTEVAR devices in which wire wrap or wire entanglement precludes access through the fenestration after deployment of the main body device. Instead of traditional attempts at de novo cannulation of the fenestration from upper extremity or femoral access, the maneuver offers an approach to maintaining through-and-through access to facilitate snaring a new wire proximal to the leading edge of the main body fabric, which can then be used to deliver a covered stent into the fenestration from either the upper extremity or femoral access. This technique offers an added benefit of potentially realigning malrotated fenestrations via tensioning of the new through-and-through wire.

逆行入路沟网(RAGS)技术:在开窗TEVAR中维持左锁骨下动脉通畅的紧急操作。
目的:本研究的目的是描述一种用于开窗胸血管内动脉瘤修复(fTEVAR)中金属丝缠绕或金属丝与近端移植物织物纠缠的新救助操作。技术:一名68岁患有高血压和慢性心房颤动的男性患者接受了选择性胸腔血管内动脉瘤修复术(TEVAR),左锁骨下开窗治疗先前A型夹层修复后残留的弓和胸主动脉瘤。由于主体移植物旋转不良,以及主体织物前缘预成形的贯通金属丝缠绕,该手术具有挑战性。描述了一种新颖的救市策略。维持贯穿式通路,并从股骨通路通过开窗输送一个长8F的鞘,从上肢通路输送一个8.5F的可操纵鞘。这允许在封闭区通过支架移植物和原生主动脉之间的沟槽同轴诱取新的贯通金属丝,这既重新定向了开窗,又允许将桥接支架放置到左侧锁骨下动脉。结论:上述逆行通道沟网(RAGS)技术提供了一种简化的方法,可以在具有挑战性的开窗胸血管内动脉瘤修复(fTEVAR)病例中取得技术成功。临床影响:本技术说明描述了逆行进入沟网圈套(RAGS)技术,该技术可以为开窗TEVAR (fTEVAR)装置提供成功的救助操作。RAGS技术提供了一种与预先设计的定制或医生修改的fTEVAR装置一起使用的方法,在这些装置中,金属丝缠绕或金属丝缠绕阻止了在主体装置部署后通过开窗进入。与传统的从上肢或股通道重新插管的尝试不同,该操作提供了一种保持贯通通道的方法,以方便在主体织物的前缘近端捕获新的金属丝,然后可用于从上肢或股通道将覆盖的支架送入开窗。这项技术提供了一个额外的好处,通过新的贯通钢丝的张力,可能重新调整旋转不良的开窗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.30
自引率
15.40%
发文量
203
审稿时长
6-12 weeks
期刊介绍: The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.
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