title: The sequential catheterization amid progressive endograft deployment technique for fenestrated endovascular aortic aneurysm repair.
abstract: Fenestrated endovascular aneurysm repair (FEVAR) is an alternative to open repair of complex aortic aneurysms. Despite promising short-term results, the technical complexities of this procedure remain a considerable challenge. The risk of technical failure with loss of visceral or renal arteries is ubiquitous even in the most experienced hands, and thus many patients with unfavorable anatomy are frequently denied FEVAR. We have adopted a new technique for FEVAR that involves retrograde brachial artery access and stepwise deployment of the endograft during target vessel catheterization, overcoming many anatomic limitations encountered from a transfemoral approach. This technique, termed sequential catheterization amid progressive endograft deployment, has become our preferred approach for FEVAR and is described in this article. Of note, currently available Food and Drug Administration-approved fenestrated endografts may not be amenable to sequential catheterization amid progressive endograft deployment as this technique requires preloaded wires incorporated into the endografts.
authors.affiliation: Division of Vascular and Endovascular Surgery, University of Texas Southwestern Medical Center, Dallas, Tex. Electronic address: carlos.timaran@utsouthwestern.edu.
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Timaran
authors.affiliation: Division of Vascular and Endovascular Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Stanley
authors.affiliation: Division of Vascular and Endovascular Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
authors.forename: M Shadman
authors.initials: MS
authors.lastname: Baig
authors.affiliation: Division of Vascular and Endovascular Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
authors.forename: David E
authors.initials: DE
authors.lastname: Timaran
authors.affiliation: Division of Vascular and Endovascular Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
authors.forename: J Gregory
authors.initials: JG
authors.lastname: Modrall
authors.affiliation: Division of Vascular and Endovascular Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
authors.forename: Martyn
authors.initials: M
authors.lastname: Knowles
mesh_terms: D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods*; D001916:Brachial Artery / Q000000981:diagnostic imaging; D002406:Catheterization, Peripheral / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D011474:Prosthesis Design; D016896:Treatment Outcome