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.
OBJECTIVE
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.


METHODS
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 CT as well as in angiographic studies of the EVAR procedure. Patients were followed up on by CT in the first 6 months.


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° before intervention to 159.4±44.6° after placement of the buddy wire (p<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.


CONCLUSIONS
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.
Abteilung für Diagnostische und Interventionelle Radiologie, Eberhard-Karls-Universität Tübingen, Germany.
D
D
Ketelsen
D
D
Bail
M
M
Heuschmid
C
C
Thomas
S
S
Heller
C D
CD
Claussen
K
K
Brechtel
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000628:therapy*; D001027:Aortography / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation* / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000379:methods*