LAUSR

AIM To report the use of the Oscor-Destino steerable sheath in challenging target visceral vessels(TVVs) cannulation/bridging stenting during fenestrated/branched endografts(FB-EVAR). METHODS Between 2016 and 2018, patients undergoing FB-EVAR for juxta/pararenal and thoracoabdominal aortic aneurysms (j/p-AAAs;TAAAs) were recorded. Cases requiring the use of the steerable sheath as planned or unplanned maneuvers were analyzed. Technical success, freedom from reinterventions (FFRs) and TVVs-patency were assessed. RESULTS Two hundred - sixty patients underwent FB-EVAR to treat j/p-AAAs and TAAAs, for an overall of 956 TVVs. Among these, the Oscor Destino steerable sheath was used in 33(13%) cases to cannulate a total of 62(7%) TVVs. FB-EVAR were performed for 7(21%) j-AAAs, 4(12%) p-AAAs, 11(61%) TAAAs and 2(6%) failed previous EVAR, respectively. The TVVs were 37(60%) renal arteries, 9(15%) superior mesenteric arteries and 16(25%) celiac trunks, respectively. The Oscor-Destino steerable sheath was used as primary cannulation approach in 29(47%) cases and after failure of the standard cannulation technique in 33(53%) cases. Technical success was achieved in 61/62(98%) TVVs. There was no 30-day mortality or bowel ischemia. At the discharge, there were no type I/III endoleaks while 4 type II endoleaks were detected. The median follow-up was 12months (IQR:8). One patient died at 6-month for aneurysm unrelated cause. No TVVs-occlusion or TVVs-related reinterventions occurred. There were no type I-III endoleaks. CONCLUSION The use of the steerable sheath could be an effective adjunctive tool and can be employed primarily as a planned technique or in case of failure of the standard cannulation technique in challenging TVVs anatomy during FB-EVAR endografting.