Language
English
Publication Date
12-1-2025
Journal
Journal of Vascular Surgery Cases, Innovations and Techniques Open access
DOI
10.1016/j.jvscit.2025.101947
PMID
41355816
PMCID
PMC12675088
PubMedCentral® Posted Date
8-6-2025
PubMedCentral® Full Text Version
Post-print
Abstract
Total transfemoral approach may be challenging in patients with narrow aortic lumens. We describe a novel total femoral staggered multibranch thoracoabdominal aortic aneurysm repair technique (FEM-SMART) to facilitate target vessel catheterization in this population. FEM-SMART is performed using a standard off-the-shelf multibranch stent graft via a total transfemoral approach. The endograft is partially deployed to the level of the celiac axis directional branch, which is selectively catheterized via contralateral femoral access using a steerable sheath. Subsequently, staggered endograft deployment, sequential catheterization of directional branches, and target vessel stenting are performed, starting with the superior mesenteric artery, followed by the renal arteries. The infrarenal segment of the endograft is then partially deployed and catheterized using the steerable sheath, which is reformed and used for catheterization and stenting of the celiac axis. Diameter-reducing ties are released, and the repair is completed in a standard fashion. Seven patients (5 males; median age, 76 years; interquartile range, 56-83 years) were treated using FEM-SMART. Technical success was 100%. There were no target vessel instabilities or major complications at a median follow-up of 2 months (interquartile range, 1.5-4.5 months). These results support FEM-SMART as a feasible technique that enables a total transfemoral approach in patients with narrow aortic lumens.
Keywords
Thoracoabdominal aortic aneurysm, Staggered deployment, Total transfemoral access, Branched endovascular aortic repair (B-EVAR), Complex aortic aneurysms, Endovascular technique
Published Open-Access
yes
Recommended Citation
Park, Jong Hun; Volpiani, Giuliano Giova; Razuk, Alvaro; et al., "Technical Pitfalls and Initial Clinical Experience Using Femoral Staggered Multibranch Thoracoabdominal Aneurysm Repair Technique" (2025). Faculty, Staff and Students Publications. 6168.
https://digitalcommons.library.tmc.edu/baylor_docs/6168