Abstract
During branched endovascular aneurysm repair, cannulation of the visceral target vessels through antegrade branches and insertion of bridging stents are frequently done from an upper extremity access. A retrograde femoral approach is a challenging alternative when an antegrade approach is not preferred. Herein, we describe a technique to increase stability of a steerable sheath, using a single suture, for bridging antegrade-facing branches from a retrograde access. This technique secures the sheath's deflected tip and provides more pushability to the steerable sheath.
Highlights
During branched endovascular aneurysm repair, cannulation of the visceral target vessels through antegrade branches and insertion of bridging stents are frequently done from an upper extremity access
Femoral access during endovascular treatment of thoracoabdominal aortic aneurysms is often combined with an upper extremity (UE) access to cannulate and to insert bridging stents into the visceral target vessels
For stent grafts with antegrade branches, a UE access may be beneficial for antegrade catheterization.[1]
Summary
Our stabilization technique for retrograde catheterization of branches was first electively performed in a 64-year-old woman with a type II thoracoabdominal aortic aneurysm with a prior history of an open ascending and arch aortic repair with proximal reimplantation of the supra-aortic vessels and frozen elephant trunk. The right femoral access was downgraded to accommodate insertion of a 14F 45-cm sheath (Check-Flo; Cook Medical) by pulling one of the ProGlide sutures. The steerable sheath along with the attached suture was introduced through the 14F sheath into the branched stent graft (Fig 1). Four branches and corresponding vessels were cannulated (Fig 2), and bridging stents (BeGraft Peripheral Plus; Bentley InnoMed GmbH, Hechingen, Germany) were placed over a Rosen wire (Cook Medical). A 7F or 8F 70-cm Flexor sheath (Cook Medical) could be advanced through the branch into the target vessel. The downward traction of the suture secured the sheath’s angle while sheaths or stents were advanced through the curved tip.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
