The “Pre-Rotating Dilator Technique” for Optimal Endograft Orientation in Complex Endovascular Aortic Repair
Karelis, Angelos LU
; Sonesson, Björn
LU
and Dias, Nuno V.
LU
(2024)
In Journal of Endovascular Therapy
- Abstract
Purpose: To describe a novel technique for optimal orientation and accurate deployment of aortic endografts during complex endovascular aortic repair (cEVAR). Technique: After establishing the femoral access in the standard fashion, a long large-bore dilator is inserted before the cEVAR delivery system. The dilator is advanced beyond the renovisceral segment noticing the degree of axial rotation. The endograft markers are verified with fluoroscopy outside the patient in the standard way. Thereafter, the cEVAR delivery system is pre-emptively rotated by the same degree in the opposite direction than the dilator showed upon insertion. The endograft is then advanced into position with the markers ending with the markers roughly in... (More)
Purpose: To describe a novel technique for optimal orientation and accurate deployment of aortic endografts during complex endovascular aortic repair (cEVAR). Technique: After establishing the femoral access in the standard fashion, a long large-bore dilator is inserted before the cEVAR delivery system. The dilator is advanced beyond the renovisceral segment noticing the degree of axial rotation. The endograft markers are verified with fluoroscopy outside the patient in the standard way. Thereafter, the cEVAR delivery system is pre-emptively rotated by the same degree in the opposite direction than the dilator showed upon insertion. The endograft is then advanced into position with the markers ending with the markers roughly in position. Minor adjustments are done before and during deployment if needed as per standard technique. Conclusion: The use of long, large-bore dilator before the introduction of the aortic graft allows to proactively minimize the risk of endograft misalignment and malrotation especially in cases with challenging anatomies in both the visceral and iliac segments. This can potentially be used in all cases because it minimizes the manipulation of the delivery system and potentially increases the accuracy of endograft deployment. Clinical Impact: This report describes a novel technique involving the use of a long large-bore dilator to predict the degree of rotation of the cEVAR delivery system during insertion and thereby enabling a pre-emptive compensation. This facilitates the precise orientation of the main aortic endograft with an easier alignment of any branches and/or fenestrations to their respective target arteries. This approach holds the potential to mitigate several of the difficulties commonly encountered with current cEVAR solutions, especially the challenges posed by small and tortuous access and severe angulation in the iliac and visceral aortic segment.
(Less)
- author
- Karelis, Angelos
LU
; Sonesson, Björn
LU
and Dias, Nuno V.
LU
- organization
- publishing date
- 2024
- type
- Contribution to journal
- publication status
- epub
- subject
- keywords
- dilator technique, endovascular aortic repair, graft orientation, predilatation dilator, tortuous anatomy
- in
- Journal of Endovascular Therapy
- publisher
- International Society of Endovascular Specialists
- external identifiers
-
- pmid:39082418
- scopus:85200267315
- ISSN
- 1526-6028
- DOI
- 10.1177/15266028241266218
- language
- English
- LU publication?
- yes
- id
- 0f587bbb-1cb4-4685-8869-b035e57eadce
- date added to LUP
- 2024-11-05 14:54:43
- date last changed
- 2025-07-16 13:01:16
@article{0f587bbb-1cb4-4685-8869-b035e57eadce,
abstract = {{<p>Purpose: To describe a novel technique for optimal orientation and accurate deployment of aortic endografts during complex endovascular aortic repair (cEVAR). Technique: After establishing the femoral access in the standard fashion, a long large-bore dilator is inserted before the cEVAR delivery system. The dilator is advanced beyond the renovisceral segment noticing the degree of axial rotation. The endograft markers are verified with fluoroscopy outside the patient in the standard way. Thereafter, the cEVAR delivery system is pre-emptively rotated by the same degree in the opposite direction than the dilator showed upon insertion. The endograft is then advanced into position with the markers ending with the markers roughly in position. Minor adjustments are done before and during deployment if needed as per standard technique. Conclusion: The use of long, large-bore dilator before the introduction of the aortic graft allows to proactively minimize the risk of endograft misalignment and malrotation especially in cases with challenging anatomies in both the visceral and iliac segments. This can potentially be used in all cases because it minimizes the manipulation of the delivery system and potentially increases the accuracy of endograft deployment. Clinical Impact: This report describes a novel technique involving the use of a long large-bore dilator to predict the degree of rotation of the cEVAR delivery system during insertion and thereby enabling a pre-emptive compensation. This facilitates the precise orientation of the main aortic endograft with an easier alignment of any branches and/or fenestrations to their respective target arteries. This approach holds the potential to mitigate several of the difficulties commonly encountered with current cEVAR solutions, especially the challenges posed by small and tortuous access and severe angulation in the iliac and visceral aortic segment.</p>}},
author = {{Karelis, Angelos and Sonesson, Björn and Dias, Nuno V.}},
issn = {{1526-6028}},
keywords = {{dilator technique; endovascular aortic repair; graft orientation; predilatation dilator; tortuous anatomy}},
language = {{eng}},
publisher = {{International Society of Endovascular Specialists}},
series = {{Journal of Endovascular Therapy}},
title = {{The “Pre-Rotating Dilator Technique” for Optimal Endograft Orientation in Complex Endovascular Aortic Repair}},
url = {{http://dx.doi.org/10.1177/15266028241266218}},
doi = {{10.1177/15266028241266218}},
year = {{2024}},
}