Abstract
Purpose: To describe a modified up-and-over access technique for treatment of iliac artery aneurysms in patients with prior bifurcated stent-grafts for endovascular aneurysm repair (EVAR). Technique: This technique uses a coaxial 12-F flexible sheath that is docked with a through-and-through wire into a 7-F sheath advanced from the contralateral femoral approach. This maneuver allows both sheaths to be moved as a unit while maintaining position of the apex of the system as it loops over the flow divider, avoiding damage to or displacing the extant endograft. Once the 12-F sheath is positioned in the iliac limb of the aortic stent-graft and secured in place with the through-and-through wire, the repair is extended into the internal iliac artery using a bridging stent-graft or covered stent introduced via a coaxial sheath. Conclusion: The up-and-over technique with a flexible 12-F sheath mated with a 7-F sheath from the opposite side allows bilateral femoral access to be used for iliac branch device placement after prior aortic endograft procedures that create a higher, acutely angled bifurcation. Use of a through-and-through wire and a coaxial sheath for stent delivery creates a very stable platform for intervention.
Original language | English (US) |
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Pages (from-to) | 21-27 |
Number of pages | 7 |
Journal | Journal of Endovascular Therapy |
Volume | 25 |
Issue number | 1 |
DOIs | |
State | Published - Feb 1 2018 |
Keywords
- abdominal aortic aneurysm
- branched stent-graft
- contralateral approach
- covered stent
- endovascular aneurysm repair
- femoral access
- iliac branch device
- internal iliac artery
- through-and-through wire
ASJC Scopus subject areas
- Surgery
- Radiology Nuclear Medicine and imaging
- Cardiology and Cardiovascular Medicine