The "Lasso-Technique": A Maneuver to Stabilize a Steerable Sheath for Transfemoral Access to Antegrade Branches in Branched Endovascular Aortic Repair-A Report of Four Cases.

Abstract

Purpose: To describe and share our experience of the "Lasso-Technique," employing a Snare® catheter combined with a small-sized 7F steerable sheath to facilitate transfemoral access to antegrade aortic branches during branched endovascular aortic repair.

Background: Cannulation of antegrade branches of a thoracoabdominal aortic stent graft via transfemoral access is technically challenging, even with a steerable sheath. For example, introducing a bridging stent may deflect the sheath cranially and prohibit successful implantation. To avoid alternative brachial access and associated complications, we employed and presented herein the "Lasso-Technique."

Technique: The tip of the 7F steerable sheath is caught using the Snare® catheter (introduced via a contralateral femoral access with a minimum sheath size of 4F), which is then locked by a mosquito clamp. While introducing the bridging stent into the target branch, the assistant stabilizes the sheath by slightly pulling the Snare-catheter.

Conclusion: The presented approach is an easily accomplished maneuver enabling transfemoral implantation of bridging stents in thoracoabdominal aortic stent grafts. Compared to similar techniques, it requires sheaths with smaller diameters (7F and 4F vs 12F) yet bilateral femoral artery puncture. It allows for hooking the sheath in the target branch, offering increased stability while being safer compared to upper extremity access approaches.Clinical ImpactThe "Lasso-Technique" is a practical and reproducible method for accessing branches during branched endovascular aortic repair (b-EVAR) procedures. The technique eliminates the need for brachial access, potentially reducing radiation exposure and complications associated with upper-extremity access. It utilizes readily available tools and small-caliber sheaths, making it easy for most vascular centers to adopt without requiring additional resources. Its straightforward design may help streamline workflows while enhancing patient safety.