Sheath-shunt technique for avoiding lower limb ischemia during complex endovascular aneurysm repair

Stephen C. Hanley, Simon K. Neequaye, Oren Steinmetz, Daniel Obrand, Kent Mackenzie, Cherrie Abraham

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Complex aortic aneurysms are now being repaired by endovascular techniques, albeit with a potentially increased risk of lower limb ischemia-reperfusion injury. We report a simple technique to maintain perfusion to the lower limb during endovascular repair, using one additional introducer sheath placed antegrade, distal to the stent graft introduction site, and connected to the side arm of the working sheath in the contralateral artery. This allows continuous perfusion of the limb distal to the main stent graft introduction site. In our initial experience with 12 cases, with confirmed occlusion of the native arterial system by the stent graft introducer sheath, arterial occlusion time was 165 ± 84 minutes. Use of the sheath-shunt technique resulted in pulsatile flow in all cases, with an average flow of 42.2 ± 13.2 mL/min, and actual ischemia time was reduced to 14 ± 11 minutes. There were no complications related to the use of this technique. Given the limited risk of this technique coupled with a potential benefit, we propose its consideration in patients undergoing complex endovascular repair.

Original languageEnglish (US)
Pages (from-to)762-766
Number of pages5
JournalJournal of Vascular Surgery
Volume62
Issue number3
DOIs
StatePublished - Sep 1 2015
Externally publishedYes

Fingerprint

Stents
Aneurysm
Lower Extremity
Ischemia
Transplants
Perfusion
Pulsatile Flow
Endovascular Procedures
Aortic Aneurysm
Reperfusion Injury
Arm
Extremities
Arteries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Sheath-shunt technique for avoiding lower limb ischemia during complex endovascular aneurysm repair. / Hanley, Stephen C.; Neequaye, Simon K.; Steinmetz, Oren; Obrand, Daniel; Mackenzie, Kent; Abraham, Cherrie.

In: Journal of Vascular Surgery, Vol. 62, No. 3, 01.09.2015, p. 762-766.

Research output: Contribution to journalArticle

Hanley, Stephen C. ; Neequaye, Simon K. ; Steinmetz, Oren ; Obrand, Daniel ; Mackenzie, Kent ; Abraham, Cherrie. / Sheath-shunt technique for avoiding lower limb ischemia during complex endovascular aneurysm repair. In: Journal of Vascular Surgery. 2015 ; Vol. 62, No. 3. pp. 762-766.
@article{a1dd932953a7497e9c81dc119875a4b2,
title = "Sheath-shunt technique for avoiding lower limb ischemia during complex endovascular aneurysm repair",
abstract = "Complex aortic aneurysms are now being repaired by endovascular techniques, albeit with a potentially increased risk of lower limb ischemia-reperfusion injury. We report a simple technique to maintain perfusion to the lower limb during endovascular repair, using one additional introducer sheath placed antegrade, distal to the stent graft introduction site, and connected to the side arm of the working sheath in the contralateral artery. This allows continuous perfusion of the limb distal to the main stent graft introduction site. In our initial experience with 12 cases, with confirmed occlusion of the native arterial system by the stent graft introducer sheath, arterial occlusion time was 165 ± 84 minutes. Use of the sheath-shunt technique resulted in pulsatile flow in all cases, with an average flow of 42.2 ± 13.2 mL/min, and actual ischemia time was reduced to 14 ± 11 minutes. There were no complications related to the use of this technique. Given the limited risk of this technique coupled with a potential benefit, we propose its consideration in patients undergoing complex endovascular repair.",
author = "Hanley, {Stephen C.} and Neequaye, {Simon K.} and Oren Steinmetz and Daniel Obrand and Kent Mackenzie and Cherrie Abraham",
year = "2015",
month = "9",
day = "1",
doi = "10.1016/j.jvs.2015.03.072",
language = "English (US)",
volume = "62",
pages = "762--766",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "3",

}

TY - JOUR

T1 - Sheath-shunt technique for avoiding lower limb ischemia during complex endovascular aneurysm repair

AU - Hanley, Stephen C.

AU - Neequaye, Simon K.

AU - Steinmetz, Oren

AU - Obrand, Daniel

AU - Mackenzie, Kent

AU - Abraham, Cherrie

PY - 2015/9/1

Y1 - 2015/9/1

N2 - Complex aortic aneurysms are now being repaired by endovascular techniques, albeit with a potentially increased risk of lower limb ischemia-reperfusion injury. We report a simple technique to maintain perfusion to the lower limb during endovascular repair, using one additional introducer sheath placed antegrade, distal to the stent graft introduction site, and connected to the side arm of the working sheath in the contralateral artery. This allows continuous perfusion of the limb distal to the main stent graft introduction site. In our initial experience with 12 cases, with confirmed occlusion of the native arterial system by the stent graft introducer sheath, arterial occlusion time was 165 ± 84 minutes. Use of the sheath-shunt technique resulted in pulsatile flow in all cases, with an average flow of 42.2 ± 13.2 mL/min, and actual ischemia time was reduced to 14 ± 11 minutes. There were no complications related to the use of this technique. Given the limited risk of this technique coupled with a potential benefit, we propose its consideration in patients undergoing complex endovascular repair.

AB - Complex aortic aneurysms are now being repaired by endovascular techniques, albeit with a potentially increased risk of lower limb ischemia-reperfusion injury. We report a simple technique to maintain perfusion to the lower limb during endovascular repair, using one additional introducer sheath placed antegrade, distal to the stent graft introduction site, and connected to the side arm of the working sheath in the contralateral artery. This allows continuous perfusion of the limb distal to the main stent graft introduction site. In our initial experience with 12 cases, with confirmed occlusion of the native arterial system by the stent graft introducer sheath, arterial occlusion time was 165 ± 84 minutes. Use of the sheath-shunt technique resulted in pulsatile flow in all cases, with an average flow of 42.2 ± 13.2 mL/min, and actual ischemia time was reduced to 14 ± 11 minutes. There were no complications related to the use of this technique. Given the limited risk of this technique coupled with a potential benefit, we propose its consideration in patients undergoing complex endovascular repair.

UR - http://www.scopus.com/inward/record.url?scp=84940614855&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84940614855&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2015.03.072

DO - 10.1016/j.jvs.2015.03.072

M3 - Article

C2 - 26033007

AN - SCOPUS:84940614855

VL - 62

SP - 762

EP - 766

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 3

ER -