Upper extremity access with Fiber Optic RealShape (FORS) guidance for Fenestrated-Branched Endovascular Aortic Aneurysm Repair (FBEVAR)
Felipe L. Pavarino, Jesus Porras-Colon, Marilisa Soto Gonzalez, Mirza S. Baig, Carlos Timaran
University of Texas Southwestern Medical Center, Dallas, TX
Objectives: Upper extremity access (UEA) is frequently required for Fenestrated-Branched Endovascular Aortic Aneurysm Repair (FBEVAR). Because of the guidewire and catheter working length of the Fiber Optic RealShape (FORS) equipment, this access is commonly avoided. The purpose of this video is to demonstrate the feasibility of performing target vessel catheterization using UEA with FORS. Methods: Using pulses of light, the FORS system allows three-dimensional visualization of guidewires and catheters. Combined with dual fluoroscopy, fusion overlay, and intravascular ultrasound (IVUS), it reduces the radiation exposure during an enlarging type III thoracoabdominal aortic aneurysm treatment. Results: The FORS catheter was connected to the docking base, fixed on the right side of the patient, and registered. A four-fenestrations single-wire preloaded device was sequentially deployed, and all target arteries were successfully cannulated using the UEA. The contralateral gate was also cannulated without radiation. The final angiogram and the pre-discharge computerized tomography angiogram confirmed technical success and exclusion of the aortic aneurysm. Conclusions: FBEVAR with FORS guidance using UEA is feasible and reduces the need of radiation for vascular navigation and vessel catheterization.
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