Use of steerable sheaths for complex aortic procedures

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Medical Device Innovation

Background:

• Standard catheters often face challenges in accessing complex vascular pathologies.
• Branched and fenestrated aortic grafts require precise target vessel cannulation.
• Cardiac electrophysiology devices may offer novel solutions for non-cardiac interventions.

Purpose of the Study:

• To evaluate the utility of cardiac-designed steerable sheaths for non-cardiac endovascular treatments.
• To assess the ease of use and effectiveness in target vessel cannulation for aortic grafts.
• To demonstrate the application of the HeartSpan Steerable Sheath (HSS) in complex vascular disease.

Main Methods:

• Retrospective review of 15 patients (2019-2022) utilizing the HeartSpan Steerable Sheath (HSS).
• Analysis of cases involving complex vascular pathology and challenging target vessel cannulation.
• Case presentation focusing on branch graft insertion via distal access and sheath characteristics.

Main Results:

• Successful cannulation and stenting in 21 out of 23 target vessels where standard approaches failed.
• HSS facilitated fenestrated endovascular graft deployment in 5 cases and full t-Branch graft deployment in 4 cases.
• Demonstrated utility in superior mesenteric artery cannulation for ischemia, iliac artery cannulation, and branched device access.

Conclusions:

• Cardiac steerable sheaths, such as the HSS, are effective for cannulating challenging vessels in aortic endovascular procedures.
• This modified approach can salvage cases otherwise deemed inoperable, especially where specialized aortic sheaths are unavailable.
• The HSS provides a viable alternative for complex endovascular interventions, enhancing treatment accessibility.