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Endo-Anchoring Guidewire Technique for Salvaging Diameter-Reducing Wire Slippage During Fenestrated Endovascular
Ye Zhao1, Yulong Huang2, Lixin Wang3
1Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
Objectives:
To describe the endo-anchoring guidewire technique for facilitating difficult catheterization and salvaging diameter-reducing wire slippage during fenestrated endovascular aneurysm repair.
Key Steps:
Recognition of diameter-reducing wire slippage by abnormal wire bowing and graft malalignment. Establishment of right brachial access for bailout control. Balloon anchoring through the superior mesenteric artery fenestration to stabilize graft orientation. Balloon-assisted endo-anchoring of the guidewire to overcome unfavorable angulation. Successful catheterization and reconstruction of all visceral branches with bridging stents.
Potential Pitfalls:
Overtightening or excessive pressurization of the delivery sheath hemostatic valve during heparinized saline priming may contribute to diameter-reducing wire slippage. Attention also should be paid to device-sheath compatibility, iliac stenosis, and excessive balloon inflation pressure.
Take-Home Messages:
The endo-anchoring guidewire technique provides a practical bailout option for difficult catheterization and complex intraoperative complications. Careful sheath management, proper wire tension, and vigilant intraoperative observation help prevent similar complications.
