Purpose: To present a technique for transfemoral implantation of parallel grafts into therenal arteries in patients with anatomy or morphology that blocks standard antegradechimney graft delivery.Technique: In a totally percutaneous approach, a 5-F pigtail angiographic catheter is passedinto the aorta above the renal arteries via a 0.035-inch hydrophilic guidewire, followed by an8-F sheath. The target vessel is cannulated with the hydrophilic wire followed by a 5-Freverse curve catheter; the wire is changed for a Rosen wire. The main stent-graft body isdelivered and parked at the level of the aortic bifurcation. The Viabahn chimney endograft isadvanced ~1 to 2 cm into the target renal artery and deployed such that its proximal endfaces downward; its distal end is fixed in place with an inflated angioplasty balloon. A stiffguidewire is inserted coaxially through the 8-F sheath, the Rosen guidewire is removed, andthe 8-F sheath is carefully pushed over the stiff guidewire, lifting the sheath and chimneyendograft upward. With the chimney reoriented cranially, the aortic stent-graft is deployedimmediately. The abdominal stent-graft and the chimney graft(s) are molded synchronouslyusing kissing balloons.Conclusion: Transfemoral placement of chimney covered stents by the lift technique incases of unsuccessful or hazardous catheterization of the target vessels via the upperextremity is safe and feasible in centers experienced with the standard chimney technique.
|Number of pages||6|
|Journal||Journal of Endovascular Therapy|
|Publication status||Published - 2013|
All Science Journal Classification (ASJC) codes
- Radiology Nuclear Medicine and imaging
- Cardiology and Cardiovascular Medicine
Pecoraro, F., Gil-Sales, J., Torsello, G., Bisdas, T., Pecoraro, F., Donas, K. P., Lachat, M., Rancic, Z., & Mayer, D. (2013). Chimney endografting for pararenal aortic pathologies using transfemoral access and the lift technique. Journal of Endovascular Therapy, 20, 492-497.