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Steerable Sheath for Cannulation and Bridging Stenting of Challenging Target Visceral Vessels in Fenestrated and Branched Endografting.

Abstract

BACKGROUND

To report the use of the Oscor Destino steerable sheath in challenging target visceral vessel (TVV) cannulation/bridging stenting in fenestrated and branched endovascular aneurysm repair (FB-EVAR).

METHODS

Between 2016 and 2018, patients undergoing FB-EVAR for juxtarenal/pararenal aneurysms (j/p-AAAs) and thoracoabdominal aortic aneurysms (TAAAs) were recorded. Cases requiring the use of the steerable sheath as planned or unplanned maneuvers were analyzed. Technical success, freedom from reinterventions, and TVV patency were assessed.

RESULTS

Two hundred sixty patients underwent FB-EVAR to treat j/p-AAAs and TAAAs, for an overall of 956 TVVs. Among these, the Oscor Destino steerable sheath was used in 33 (13%) cases to cannulate a total of 62 (7%) TVVs. FB-EVAR was performed for 7 (21%) j-AAAs, 4 (12%) p-AAAs, 11 (61%) TAAAs, and 2 (6%) previously failed EVAR. The TVVs were 37 (60%) renal arteries, 9 (15%) superior mesenteric arteries, and 16 (25%) celiac trunks. The Oscor Destino steerable sheath was used as the primary cannulation approach in 29 (47%) cases and after failure of the standard cannulation technique in 33 (53%) cases. Technical success was achieved in 61/62 (98%) TVVs. There was no 30-day mortality or bowel ischemia. At the discharge, there were no type I/III endoleaks, whereas 4 type II endoleaks were detected. The median follow-up was 12 months (interquartile range: 8). One patient died at 6 months because of aneurysm-unrelated cause. No TVV occlusion or TVV-related reinterventions occurred. There were no type I-III endoleaks.

CONCLUSIONS

The use of the steerable sheath could be an effective adjunctive tool and can be used primarily as a planned technique or in case of failure of the standard cannulation technique in challenging TVV anatomy during FB-EVAR.

Authors+Show Affiliations

Vascular Surgery, Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy. Electronic address: enrico.gallitto@gmail.com.Vascular Surgery, Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy.Division of Vascular Surgery, Vita - Salute" University, Scientific Institute H. San Raffaele, Milan, Italy.Vascular and Endovascular Surgery Unit, IRCCS - Ospedale Policlinico San Martino, University of Genoa, Genova, Italy.Division of Vascular Surgery, Santa Azienda Ospedaliera di Perugia, Perugia, Italy.Vascular Surgery, Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy.Vascular Surgery, Department of Biomedicine and Prevention, University of Rome, Tor Vergata, Rome, Italy.Division of Vascular Surgery, Santa Azienda Ospedaliera di Perugia, Perugia, Italy.Division of Vascular Surgery, Vita - Salute" University, Scientific Institute H. San Raffaele, Milan, Italy.Vascular Surgery, Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31857228

Citation

Gallitto, Enrico, et al. "Steerable Sheath for Cannulation and Bridging Stenting of Challenging Target Visceral Vessels in Fenestrated and Branched Endografting." Annals of Vascular Surgery, 2019.
Gallitto E, Faggioli G, Bertoglio L, et al. Steerable Sheath for Cannulation and Bridging Stenting of Challenging Target Visceral Vessels in Fenestrated and Branched Endografting. Ann Vasc Surg. 2019.
Gallitto, E., Faggioli, G., Bertoglio, L., Pratesi, G., Isernia, G., Goretti, M., ... Gargiulo, M. (2019). Steerable Sheath for Cannulation and Bridging Stenting of Challenging Target Visceral Vessels in Fenestrated and Branched Endografting. Annals of Vascular Surgery, doi:10.1016/j.avsg.2019.11.039.
Gallitto E, et al. Steerable Sheath for Cannulation and Bridging Stenting of Challenging Target Visceral Vessels in Fenestrated and Branched Endografting. Ann Vasc Surg. 2019 Dec 16; PubMed PMID: 31857228.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Steerable Sheath for Cannulation and Bridging Stenting of Challenging Target Visceral Vessels in Fenestrated and Branched Endografting. AU - Gallitto,Enrico, AU - Faggioli,Gianluca, AU - Bertoglio,Luca, AU - Pratesi,Giovanni, AU - Isernia,Giacomo, AU - Goretti,Martina, AU - Ippoliti,Arnaldo, AU - Lenti,Massimo, AU - Chiesa,Roberto, AU - Gargiulo,Mauro, Y1 - 2019/12/16/ PY - 2019/10/12/received PY - 2019/11/24/revised PY - 2019/11/25/accepted PY - 2019/12/21/pubmed PY - 2019/12/21/medline PY - 2019/12/21/entrez JF - Annals of vascular surgery JO - Ann Vasc Surg N2 - BACKGROUND: To report the use of the Oscor Destino steerable sheath in challenging target visceral vessel (TVV) cannulation/bridging stenting in fenestrated and branched endovascular aneurysm repair (FB-EVAR). METHODS: Between 2016 and 2018, patients undergoing FB-EVAR for juxtarenal/pararenal aneurysms (j/p-AAAs) and thoracoabdominal aortic aneurysms (TAAAs) were recorded. Cases requiring the use of the steerable sheath as planned or unplanned maneuvers were analyzed. Technical success, freedom from reinterventions, and TVV patency were assessed. RESULTS: Two hundred sixty patients underwent FB-EVAR to treat j/p-AAAs and TAAAs, for an overall of 956 TVVs. Among these, the Oscor Destino steerable sheath was used in 33 (13%) cases to cannulate a total of 62 (7%) TVVs. FB-EVAR was performed for 7 (21%) j-AAAs, 4 (12%) p-AAAs, 11 (61%) TAAAs, and 2 (6%) previously failed EVAR. The TVVs were 37 (60%) renal arteries, 9 (15%) superior mesenteric arteries, and 16 (25%) celiac trunks. The Oscor Destino steerable sheath was used as the primary cannulation approach in 29 (47%) cases and after failure of the standard cannulation technique in 33 (53%) cases. Technical success was achieved in 61/62 (98%) TVVs. There was no 30-day mortality or bowel ischemia. At the discharge, there were no type I/III endoleaks, whereas 4 type II endoleaks were detected. The median follow-up was 12 months (interquartile range: 8). One patient died at 6 months because of aneurysm-unrelated cause. No TVV occlusion or TVV-related reinterventions occurred. There were no type I-III endoleaks. CONCLUSIONS: The use of the steerable sheath could be an effective adjunctive tool and can be used primarily as a planned technique or in case of failure of the standard cannulation technique in challenging TVV anatomy during FB-EVAR. SN - 1615-5947 UR - https://www.unboundmedicine.com/medline/citation/31857228/Steerable_Sheath_for_Cannulation_and_Bridging_Stenting_of_Challenging_Target_Visceral_Vessels_in_Fenestrated_and_Branched_Endografting L2 - https://linkinghub.elsevier.com/retrieve/pii/S0890-5096(19)31038-6 DB - PRIME DP - Unbound Medicine ER -