TY - JOUR
T1 - Sheath-shunt technique for avoiding lower limb ischemia during complex endovascular aneurysm repair
AU - Hanley, Stephen C.
AU - Neequaye, Simon K.
AU - Steinmetz, Oren
AU - Obrand, Daniel
AU - Mackenzie, Kent
AU - Abraham, Cherrie Z.
N1 - Publisher Copyright:
© 2015 Society for Vascular Surgery.
PY - 2015/9/1
Y1 - 2015/9/1
N2 - Complex aortic aneurysms are now being repaired by endovascular techniques, albeit with a potentially increased risk of lower limb ischemia-reperfusion injury. We report a simple technique to maintain perfusion to the lower limb during endovascular repair, using one additional introducer sheath placed antegrade, distal to the stent graft introduction site, and connected to the side arm of the working sheath in the contralateral artery. This allows continuous perfusion of the limb distal to the main stent graft introduction site. In our initial experience with 12 cases, with confirmed occlusion of the native arterial system by the stent graft introducer sheath, arterial occlusion time was 165 ± 84 minutes. Use of the sheath-shunt technique resulted in pulsatile flow in all cases, with an average flow of 42.2 ± 13.2 mL/min, and actual ischemia time was reduced to 14 ± 11 minutes. There were no complications related to the use of this technique. Given the limited risk of this technique coupled with a potential benefit, we propose its consideration in patients undergoing complex endovascular repair.
AB - Complex aortic aneurysms are now being repaired by endovascular techniques, albeit with a potentially increased risk of lower limb ischemia-reperfusion injury. We report a simple technique to maintain perfusion to the lower limb during endovascular repair, using one additional introducer sheath placed antegrade, distal to the stent graft introduction site, and connected to the side arm of the working sheath in the contralateral artery. This allows continuous perfusion of the limb distal to the main stent graft introduction site. In our initial experience with 12 cases, with confirmed occlusion of the native arterial system by the stent graft introducer sheath, arterial occlusion time was 165 ± 84 minutes. Use of the sheath-shunt technique resulted in pulsatile flow in all cases, with an average flow of 42.2 ± 13.2 mL/min, and actual ischemia time was reduced to 14 ± 11 minutes. There were no complications related to the use of this technique. Given the limited risk of this technique coupled with a potential benefit, we propose its consideration in patients undergoing complex endovascular repair.
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U2 - 10.1016/j.jvs.2015.03.072
DO - 10.1016/j.jvs.2015.03.072
M3 - Article
C2 - 26033007
AN - SCOPUS:84940614855
SN - 0741-5214
VL - 62
SP - 762
EP - 766
JO - Journal of vascular surgery
JF - Journal of vascular surgery
IS - 3
ER -