Introduction:

the treatment of complex aneurysms using FEVAR includes among its objectives a reduced surgical time in order to achieve technical and clinical success. However, cannulation and implantation of bridging stents in multiple visceral arteries can be a limiting factor. To avoid a protracted scope time and radiation dose, there are some maneuvers that can help optimize catheterization time.

Material and methods:

a review of the last cases treated with custom made Zenith Cook® fenestrated endoprostheses during the year 2021 is performed in an angiology, vascular and endovascular surgery service. The objective is to show video clips recorded with the OneView system of these techniques that the surgeon can use with the usual material to optimize the treatment of complex aneurysms.

Results:

the first key step is the release of the fenestrated device. The Cook® endoprosthesis has one or more reduction ligatures that keep it puckered until it guarantees correct orientation and positioning, as well as the option of cannulating the visceral arteries between the arterial wall and the device.

With proper planning and a systematic approach, the use of coaxial guides with single or reverse tip catheters and introducers are essential. The roof of the endoprosthesis allows the advancement of guides and introducers with sufficient support for their cannulation. The preloaded systems allow cannulation from the upper or lower limb. In the latter case, a 0.014” buddy guide is used to provide support for the introducer, bringing it even closer to fenestration in such a way as to enhance the torque and thrust of the catheter.

In addition, we have the “swallowing” maneuver or emptying of a balloon catheter while advancing the introducer on a guide towards the target artery. We also have deflectable inserters that orient their tip with a more accentuated flexion if necessary.

Conclusions:

success in FEVAR includes optimization of surgical time, reduction of lower limb ischemia time, radiation dose and anesthetic time. This highlights the importance of having in-depth knowledge of the devices used in the operating room, the materials used, and the salvage options in visceral vessel cannulation.

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