In situ introducer sheath dilatation for complex aortic access.
Aortic access problems due to diseased or small peripheral vessels are a major issue in endovascular aneurysm repair (EVAR). In the emergency setting, like aortic rupture after blunt trauma, or in patients with a hostile abdomen, a more proximal access to the aorta is not a pleasant perspective. We developed in situ introducer sheath dilatation as a bail-out technique for patients with difficult aortic access under various circumstances including EVAR, intra-aortic balloon pump insertion and cannulation for perfusion. The method described allows to increase the access vessel diameter by 50% (from 6 to 9 mm) or the luminal circumference from 18 to 27 F. We have used this technique in five patients without complication, very much in contrast to the traditionally practiced 'forced device insertion'.
Department for Cardio-vascular Surgery, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland. ludwig.von-segesser@chuv.hospvd.ch
Ludwig K
LK
von Segesser
Bettina
B
Marty
Pier-Giorgio
PG
Tozzi
Antonio
A
Corno
D001014:Aortic Aneurysm / Q000601:surgery*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000295:instrumentation*