In situ introducer sheath dilatation for complex aortic access

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Medical Device Technology

Background:

• Peripheral vessel disease and small vessel size pose significant challenges for aortic access in endovascular aneurysm repair (EVAR).
• Emergency scenarios, such as aortic rupture or hostile abdomen, necessitate alternative aortic access strategies.
• Traditional methods for managing difficult access can lead to complications.

Purpose of the Study:

• To introduce and evaluate a novel bail-out technique for achieving aortic access in challenging clinical situations.
• To demonstrate the safety and efficacy of in situ introducer sheath dilatation.

Main Methods:

• In situ introducer sheath dilatation was developed as a technique to increase the diameter of the access vessel.
• The method was applied in patients requiring aortic access for EVAR, intra-aortic balloon pump insertion, and perfusion cannulation.

Main Results:

• The technique successfully increased the access vessel diameter by 50% (from 6 mm to 9 mm), corresponding to a luminal circumference increase from 18 F to 27 F.
• The procedure was performed in five patients across various clinical scenarios without any reported complications.
• This contrasts favorably with the risks associated with traditional 'forced device insertion' methods.

Conclusions:

• In situ introducer sheath dilatation is a safe and effective bail-out technique for managing difficult aortic access.
• This method offers a viable solution for complex EVAR cases and other aortic interventions where standard access is compromised.
• It provides a valuable alternative to potentially hazardous forced device insertion techniques.