Modified Snare-Ride Technique for Target Vessel Stenting in FB-EVAR

Area of Science:

• Endovascular Surgery
• Vascular Surgery
• Interventional Radiology

Background:

• Branched and fenestrated endografts are crucial for treating complex aortic aneurysms, enabling visceral vessel preservation.
• Target vessel cannulation is a technically demanding step in fenestrated and branched endovascular aneurysm repair (FEVAR/BEVAR), especially in patients with hostile anatomy.
• Existing bailout strategies, like the snare-ride technique, can pose risks such as endothelial trauma.

Purpose of the Study:

• To introduce a Modified Snare-Ride Technique as a safer and more effective bailout strategy for target vessel cannulation in complex anatomies.
• To mitigate the risks of vascular injury associated with traditional endovascular catheterization methods.

Main Methods:

• The Modified Snare-Ride Technique involves establishing through-and-through access from the portal to the contralateral stiff sheath.
• A stiff sheath is advanced to the target vessel origin, pinning a through-and-through wire.
• The portal sheath is then advanced over this wire for cannulation, avoiding direct advancement of the snare system into the vessel.

Main Results:

• The modified technique enhances wire support and control using deflectable sheaths.
• It minimizes mechanical damage to the vessel wall by avoiding snare advancement into the target vessel.
• Usability is dependent on device and sheath size compatibility.

Conclusions:

• The Modified Snare-Ride Technique offers a reproducible bailout strategy for challenging target vessel cannulation in FEVAR/BEVAR.
• It potentially reduces visceral artery injury compared to the original snare-ride technique.
• This approach may expand endovascular treatment options for complex aortic pathologies.