Endovascular resuscitation for ruptured abdominal aortic aneurysms with main stent-graft and REBOA via single-sided access

2018 ◽  
Vol 2 (3) ◽  
Author(s):  
David T McGreevy ◽  
Tal M Hörer ◽  
Artai Pirouzram
Keyword(s):  
Stent Graft ◽  
Vascular Access ◽  
Abdominal Aortic Aneurysms ◽  
Balloon Occlusion ◽  
Aortic Aneurysms ◽  
Team Approach ◽  
Femoral Access ◽  
Aortic Stent Graft ◽  
Abdominal Aortic ◽  
Ruptured Abdominal Aortic Aneurysms

Background Aortic Balloon Occlusion or Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for hemorrhage control during endovascular aortic repair (EVAR) is a technique that has been used for decades for ruptured abdominal aortic aneurysms (rAAA). This usually requires bilateral femoral access, however, when only single-sided vascular access can be obtained this complicates the procedure if these techniques are to be used. We present two cases of single-sided vascular access, recently performed at our institution, using simultaneous REBOA and aortic stent-graft placement during EVAR in rAAA.   Methods and Results This is a description of two clinical cases where REBOA and EVAR were performed through single-sided vascular access for the treatment of rAAA at Örebro University Hospital between March 2018 and June 2018.   Conclusion This case report demonstrates that despite the limitation of single-sided access, an aortic stent-graft can be placed for treatment of a rAAA during continuous aortic occlusion with REBOA, facilitated by using a multidisciplinary EVTM team approach.

Expanded Suitability of Ruptured Abdominal Aortic Aneurysms for Total Endovascular Repair Using the Endurant Endograft and Heli-FX EndoAnchors

2019 ◽  
Vol 26 (2) ◽  
pp. 245-249 ◽  
Author(s):  
Andrés Reyes Valdivia ◽  
Francisco Álvarez Marcos ◽  
África Duque Santos ◽  
Julia Ocaña Guaita ◽  
Claudio Gandarias Zúñiga
Keyword(s):  
Endovascular Treatment ◽  
Stent Graft ◽  
Tertiary Care ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Study Cohort ◽  
Neck Length ◽  
Entire Study ◽  
Abdominal Aortic ◽  
Ruptured Abdominal Aortic Aneurysms

Purpose: To assess if the suitability of endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs) can be expanded by combining the Endurant stent-graft with the Heli-FX EndoAnchors. Materials and Methods: Contrast-enhanced computed tomography (CT) scans of 90 patients (mean age 73.2±9 years; 87 men) with RAAA admitted between January 2014 and January 2018 in 2 tertiary care centers were analyzed in a 3-dimensional workstation. Anatomical features of the aneurysms according to the instructions for use (IFU) for the Endurant endograft were evaluated and expansion of treatment with Heli-FX EndoAnchors was assessed. Results: Neck length <10 mm was present in 41 (45.6%) patients; 5 had neck diameters outside the IFU and 45 (50.0%) had conical necks. Thrombus and calcium were absent in 63 (70.0%) and 73 (81.1%), respectively. In the study cohort, 44 (48.9%) patients met all the neck criteria, although overall IFU compliance was found in only 35 (38.9%) patients due to iliac-related issues in 21 patients. The adjunctive use of EndoAnchors in the entire study group would enhance the therapeutic range to an additional 24 patients, 8 of whom would need an associated iliac procedure. This represents an expansion of the total EVAR approach from 48.9% to 75.6% of cases if some iliac issues are overcome and from 38.9% to 56.7% without correcting iliac deficiencies. Conclusion: The main reason of being unfit for endovascular treatment in this series was neck length <10 mm. Based on this analysis, nearly 40% of RAAA patients would have been candidates for EVAR based on the IFU neck criteria for the Endurant stent-graft. This suitability could be nearly doubled with the use of EndoAnchors and correction of unsuitable iliac anatomy. The use of EndoAnchors has the potential to offer a significant benefit in the endovascular treatment of RAAA patients.

Access From Above—Bailout Solution for Intraoperative Distal Migration of Abdominal Aortic Stent Graft

2017 ◽  
Vol 51 (5) ◽  
pp. 338-341
Author(s):  
Dimitrij Kuhelj ◽  
Jernej Avsenik ◽  
Dašmir Nuredini
Keyword(s):  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Emergency Setting ◽  
Landing Zone ◽  
Aneurysm Neck ◽  
Chimney Technique ◽  
Aortic Stent Graft ◽  
Abdominal Aortic ◽  
Distal Migration ◽  
Ruptured Abdominal Aortic Aneurysms

The majority of the ruptured abdominal aortic aneurysms today is treated endovascularly. In cases with short aneurysm neck, chimney technique can be used to extend landing zone in emergency setting. Additionally, the repositioning ability of C3 delivery system (Gore & Associates) allows better positioning in cases with challenging anatomy. In our experience, proximal reposition of partially deployed device can be problematic in some patients. We present a case of endovascular repair of ruptured abdominal aortic aneurysm using chimney technique where proximal reposition was achieved by snaring the aortic device via axillary access.

Change in Aneurysm Diameter After Stent-Graft Repair of Ruptured Abdominal Aortic Aneurysms

2004 ◽  
Vol 11 (3) ◽  
pp. 319-322 ◽  
Author(s):  
Nityanand Arya ◽  
Bernard Lee ◽  
William Loan ◽  
Lynn Christie Johnston ◽  
Christopher Sydney Boyd ◽  
...  
Keyword(s):  
Stent Graft ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Abdominal Aortic ◽  
Stent Graft Repair ◽  
Ruptured Abdominal Aortic Aneurysms ◽  
Aneurysm Diameter

scholarly journals Improved stability of steerable sheath access by femoro-femoral crossover wire in branched stent graft repair of complex thoraco-abdominal aortic aneurysms

2020 ◽  
Vol 5 (1-2) ◽  
pp. 63-65
Author(s):  
Ingolf Töpel ◽  
Thomas Betz ◽  
Markus Steinbauer ◽  
Christian Uhl
Keyword(s):  
Upper Extremity ◽  
Stent Graft ◽  
Endovascular Repair ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Femoral Access ◽  
Abdominal Aortic ◽  
Improved Stability ◽  
Stent Graft Repair ◽  
Steerable Sheath

AbstractPurposeThe purpose of this study was to describe a technique to catheterize antegrade branches of a branched aortic endograft by using a steerable sheath stabilized by a through-and-through wire via a femoral access.TechniqueAfter implantation of a branched endovascular graft, a steerable 8.5 F sheath is advanced from the femoral access. After placing the sheath proximal to the branches, a 0.014″ through-and-through wire is established to the contralateral femoral access which is held under slight traction after the curved tip of the sheath is brought into the 180° position. Then catheterization, wire exchange and deployment of the bridging stent is done in standard fashion.ConclusionThe use of a through-and-through wire with a steerable sheath for retrograde femoral access adds stability and precision to this technique. It has the potential to reduce the risk of preoperative stroke in complex aortic endovascular repair by avoiding upper extremity access.

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