title: Sheath-shunt technique for avoiding lower limb ischemia during complex endovascular aneurysm repair.
abstract: 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.
authors.affiliation: Division of General Surgery, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: stephen.hanley@mail.mcgill.ca.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Hanley
authors.affiliation: Department of Vascular Surgery, Royal Liverpool and Broadgreen University Hospitals, Liverpool, United Kingdom.
authors.forename: Simon K
authors.initials: SK
authors.lastname: Neequaye
authors.affiliation: Division of Vascular Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Oren
authors.initials: O
authors.lastname: Steinmetz
authors.affiliation: Division of Vascular Surgery, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Obrand
authors.affiliation: Division of Vascular Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Kent
authors.initials: K
authors.lastname: Mackenzie
authors.affiliation: Division of Vascular Surgery, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Cherrie Z
authors.initials: CZ
authors.lastname: Abraham
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001783:Blood Flow Velocity; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D012039:Regional Blood Flow; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D062666:Vascular Access Devices