title: A variant deployment technique for the powerlink bifurcated endograft.
abstract: OBJECTIVE
  To report an alternative technique to the dual-lumen catheter for deployment of the Powerlink stent-graft in patients with angulated sacs and calcified aortic bifurcations. A maneuver is also presented to retrieve the delivery system when it is snagged on the stent.
  
  
  METHODS
  After cutdown of the right common femoral artery (CFA), a 9-F introducer sheath is placed percutaneously into the left CFA. A gooseneck catheter is introduced from the right CFA to capture a 0.035-inch hydrophilic guidewire inserted from the left. A 5-F straight catheter is passed over this guidewire from the left to the right CFA. In angulated aneurysm sacs, a 5-F Hunter catheter is introduced from the right femoral access to support a guidewire through the aneurysm to the suprarenal aorta. Then the guidewire is exchanged with a 0.035-inch Amplatz extra stiff wire, and the Hunter catheter is removed. In other cases, a 0.035-inch Amplatz extra stiff guidewire is placed up to the suprarenal aorta. The endograft delivery system is then deployed in the usual manner. A gooseneck snare is also useful in retrieving the delivery system when it is snagged on the stent at the endograft bifurcation.
  
  
  CONCLUSIONS
  This variant technique facilitates the deployment of the Powerlink stent-graft when faced with angulated aneurysms or acute and calcified aortic bifurcations. A gooseneck catheter is helpful in retrieving the delivery system's "olive" after endograft placement.
authors.affiliation: 1st Unit of Vascular Surgery, School of Vascular Surgery, Istituto Policlinico San Donato, University of Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Nano
authors.forename: Ilias
authors.initials: I
authors.lastname: Dalainas
authors.forename: Piero
authors.initials: P
authors.lastname: Volpe
authors.forename: Renato
authors.initials: R
authors.lastname: Casana
authors.forename: Tommaso
authors.initials: T
authors.lastname: Lupattelli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Paroni
authors.forename: Luigi
authors.initials: L
authors.lastname: Inglese
authors.forename: Domenico G
authors.initials: DG
authors.lastname: Tealdi
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D020099:Coated Materials, Biocompatible; D020878:Device Removal; D006801:Humans; D011474:Prosthesis Design; D015607:Stents
chemical_list: D020099:Coated Materials, Biocompatible