The “safe-line” technique as theoretical additional attempt to mitigate spinal cord ischemia after urgent complete endovascular exclusion of a thoracoabdominal aortic aneurysm

Michele Piazza, MD; Francesco Squizzato, MD; Marco James Bilato, MD; Edoardo Forcella, MD; Franco Grego, MD; Michele Antonello, MD, PhD

Journal of Vascular Surgery Cases and Innovative Techniques (Sep 2023)

The “safe-line” technique as theoretical additional attempt to mitigate spinal cord ischemia after urgent complete endovascular exclusion of a thoracoabdominal aortic aneurysm

Michele Piazza, MD,
Francesco Squizzato, MD,
Marco James Bilato, MD,
Edoardo Forcella, MD,
Franco Grego, MD,
Michele Antonello, MD, PhD

Affiliations

Michele Piazza, MD: Correspondence: Michele Piazza, MD, Vascular and Endovascular Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, School of Medicine, Padua University, Via Giustiniani 2, Padua 35125, Italy; Vascular and Endovascular Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, School of Medicine, Padua University, Padua, Italy
Francesco Squizzato, MD: Vascular and Endovascular Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, School of Medicine, Padua University, Padua, Italy
Marco James Bilato, MD: Vascular and Endovascular Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, School of Medicine, Padua University, Padua, Italy
Edoardo Forcella, MD: Vascular and Endovascular Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, School of Medicine, Padua University, Padua, Italy
Franco Grego, MD: Vascular and Endovascular Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, School of Medicine, Padua University, Padua, Italy
Michele Antonello, MD, PhD: Vascular and Endovascular Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, School of Medicine, Padua University, Padua, Italy

Journal volume & issue: Vol. 9, no. 3
p. 101215

Abstract

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We describe the feasibility of a technique for temporary aneurysm sac reperfusion after endovascular single-stage thoracoabdominal aortic aneurysm exclusion, to be used in the case of postoperative spinal cord ischemia. Two cases were treated for impending rupture of a thoracoabdominal aortic aneurysm. Before completion of sac exclusion, a supplementary buddy wire (V-18 control guidewire; Boston Scientific) was advanced in parallel fashion from the left percutaneous femoral access into the aneurysmal sac on the posterior aspect of the endograft. Distal aneurysm exclusion was completed using the main superstiff guidewire, and the femoral access was closed with a percutaneous closure device (ProGlide; Abbott) in standard fashion, leaving in place the sole V-18 guidewire, draped in sterile fashion. In the case of spinal cord ischemia, the “safe-line” can be rapidly used for spinal reperfusion after trans-sealing exchange with a 6F, 65-cm-long Destination sheath (Terumo) connected to a 6F introducer on the contralateral femoral artery.

Published in Journal of Vascular Surgery Cases and Innovative Techniques

ISSN: 2468-4287 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Surgery; Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.sciencedirect.com/journal/journal-of-vascular-surgery-cases-innovations-and-techniques

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