Use of Heli-Fx guide steerable sheath for transfemoral mono-chimney endografting associated to endoanchors for type IA endoleak correction

Abstract

Chimney endovascular aneurysm repair (ChEVAR) is an accepted alternative for abdominal aortic aneurysm (AAA) treatment in patients with complex anatomy or urgent cases. In selected high-risk patients, the association with Endoanchors seems attractive and could potentially reduce type IA endoleak rate. Moreover, the transfemoral approach for ChEVAR is a validated option when the transbrachial access is not feasible or contraindicated and recent works have highlighted the use of steerable sheaths as a method to achieve total transfemoral ChEVAR. The study reports two successful secondary procedures for a type IA endoleak treated with a single renal chimney endografting plus Endoanchors. These procedures were performed from the femoral access using Heli-Fx Guide 22 mm steerable sheath (Medtronic, Santa Rosa, CA) associated with a coaxial Flexor Introducer (Cook Medical Inc., Bloomington, IN). Technical steps are accurately underlined to make the procedure reproducible. ChEVAR from femoral arteries with Heli-Fx Guide 22 mm steerable sheath associated with a telescopic 90 cm Flexor seems feasible and safe following some specific technical hints.

Keywords

• Endovascular aneurysm repair
• Chimney endografting
• Transfemoral approach
• Steerable sheath
• Heli-FX guide sheath
• Technique