Sheath-shunt technique for avoiding lower limb ischemia during complex endovascular aneurysm repair

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortic Aneurysm Repair

Background:

• Endovascular repair of complex aortic aneurysms is advancing.
• A potential risk associated with these procedures is lower limb ischemia-reperfusion injury.
• Maintaining adequate blood flow to the lower extremities during repair is crucial.

Purpose of the Study:

• To introduce and evaluate a simple technique for maintaining lower limb perfusion during endovascular aortic aneurysm repair.
• To assess the efficacy and safety of the proposed sheath-shunt technique in preventing limb ischemia.

Main Methods:

• A technique involving an additional antegrade introducer sheath placed distal to the stent graft site was employed.
• This sheath was connected to the working sheath's side arm in the contralateral artery, creating a shunt.
• The technique was applied in 12 patients undergoing complex endovascular aortic aneurysm repair.

Main Results:

• The sheath-shunt technique ensured continuous pulsatile flow to the lower limb in all cases.
• Average limb perfusion flow was 42.2 ± 13.2 mL/min.
• Actual limb ischemia time was significantly reduced to an average of 14 ± 11 minutes, compared to the arterial occlusion time of 165 ± 84 minutes.

Conclusions:

• The sheath-shunt technique is a simple and effective method to maintain lower limb perfusion during complex endovascular aortic aneurysm repair.
• This technique poses minimal risk and can significantly reduce limb ischemia time.
• It is proposed as a valuable consideration for patients undergoing these complex endovascular procedures.