A Technical Approach for Transfemoral Managing of Hostile Angulated Pelvic Vessel Access in Abdominal Endovascular Aneurysm Repair: A New Technique for Establishing a Buddy Wire

作者：Ketelsen D; Bail D; Heuschmid M; Thomas C; Heller S; Claussen C D; Brechtel K^*

来源：RoFo-Fortschritte auf dem Gebiet der Rontgenstrahlen und der Bildgebenden Verfahren, 2012, 184(10): 899-904.

DOI：10.1055/s-0032-1312964

• aorta
• angiography
• interventional procedures
• stents
• aneurysm
• technical aspects

Purpose: Endovascular aneurysm repair (EVAR) can be challenging in angulated access vessels. The aim of this study was to evaluate a new wire technique for installing a buddy wire in the event of failure of simple advancing of a super stiff guide. %26lt;br%26gt;Materials and Method: We investigated 8 patients eligible for EVAR. All patients presented with heavily kinked pelvic access and failure of primary advancing of a stiff guide wire through a placed catheter. A double wire technique with a combination of soft and stiff wires was applied to place a super stiff buddy wire. Cumulative angulation quantified by the sum of angles of the tortuous pelvic access vessels was measured in pre- and post-interventional Cl as well as in angiographic studies of the EVAR procedure. Patients were followed up on by CT in the first 6 months. %26lt;br%26gt;Results: A buddy wire could be installed in all patients (100%) with significant straightening of the access vessel from a median cumulative angulation of 252.4 +/- 38.1 degrees before intervention to 159.4 +/- 44.6 degrees after placement of the buddy wire (p %26lt; 0.001). There was no technical failure of device passage and all stent-grafts could be deployed safely. Three cases of stenosis caused by torsion distal to the aortic stent-graft were seen after stent-graft delivery. One case of stenosis was hemodynamically relevant and was successfully stented. No major adverse events occurred within the first 6 months of follow-up. %26lt;br%26gt;Conclusion: The new step-by-step wire technique is feasible and safe in the case of hostile pelvic vessel access, and facilitates the advancement of aortic stent-grafts in off-label patients.

• 出版日期2012-10