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. 2023 Sep 28;12(19):6263.
doi: 10.3390/jcm12196263.

Outcome Analysis of Speed Gate Cannulation during Standard Infrarenal Endovascular Aneurysm Repair

Domenico Mirabella  1 , Salvatore Evola  2 , Ettore Dinoto  1 , Carlo Setacci  3 , David Pakeliani  4 , Francesco Setacci  5   6 , Paolo Annicchiarico  1 , Felice Pecoraro  1   7
Affiliations

Outcome Analysis of Speed Gate Cannulation during Standard Infrarenal Endovascular Aneurysm Repair

Domenico Mirabella et al. J Clin Med. .

Abstract

Background: Endovascular aortic repair (EVAR) is generally performed with bi/trimodular stent-grafts requiring retrograde contralateral gate cannulation (CGC). In the case of tricky CGC, an increased EVAR procedural time and radiation exposure have been reported. Herein, we compare the outcomes of conventional CGC and CGC using the speed gate cannulation (SGC) technique in standard EVAR for a propensity-matched cohort.

Methods: A total of 371 patients were retrospectively analyzed. Inclusion criteria were fulfilled in 172 patients who underwent propensity score matching. Primary outcomes included operative time, CGC time, mean contrast medium, fluoroscopy time, and CGC fluoroscopy time.

Results: After matching, 78 patients were included in each group (SGC vs. standard). Primary outcomes registered a significant reduction in CGC time (4 [1-6] vs. 8 [6-14] min; p = 0.001) and fluoroscopy time (12 [9-16] vs. 17 [12-25] min).

Conclusions: In this preliminary experiment, the use of SGC was feasible with no significant registered postoperative complications. A significant reduction in contrast medium usage, radiation exposure, and CGC time was observed with the use of SGC. SGC is a simple adjunctive technique, and its use should be considered in standard EVAR, especially in emergency scenarios, where time is of the essence.

Keywords: EVAR; abdominal aortic aneurysm; cannulation; contralateral limb; gate; speed gate cannulation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) Short dilator and parallel 0.035-inch standard J-tip guide-wire through the Dryseal introducer. (B) A 5 Fr pigtail angiographic catheter advancement.
Figure 2
Figure 2
(A) Main body introduction before orientation towards the contralateral supported sheath route. (B) Main body rotation to orientate the distal markers of the contralateral gate in the direction of the route of the contralateral wires.
Figure 3
Figure 3
(A) Contralateral supported sheath lowering below the contralateral gate radiopaque markers and main body deployment in ballerina configuration. (B) Contralateral gate cannulation with buddy wire through the contralateral supported sheath.
Figure 4
Figure 4
Population flow chart.
Figure 5
Figure 5
(A) Survival and (B) freedom from reintervention estimated from 3-year Kaplan–Meier curves for standard contralateral gate cannulation and speed gate cannulation. Standard error does not exceed 10% at 3 years for both survival curves.
See this image and copyright information in PMC

References

    1. Steuer J., Lachat M., Veith F.J., Wanhainen A. Endovascular grafts for abdominal aortic aneurysm. Eur. Heart J. 2016;37:145–151. doi: 10.1093/eurheartj/ehv593. - DOI - PubMed
    1. Pakeliani D., Lachat M., Blohmé L., Kobayashi M., Chaykovska L., Pfammatter T., Puippe G., Veith F.J., Pecoraro F. Improved technique for sheath supported contralateral limb gate cannulation in endovascular abdominal aortic aneurysm repair. Vasa. 2020;49:39–42. doi: 10.1024/0301-1526/a000820. Erratum in Vasa 2021, 50, 158. - DOI - PubMed
    1. von Elm E., Altman D.G., Egger M., Pocock S.J., Gøtzsche P.C., Vandenbroucke J.P. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies. Epidemiology. 2007;18:800–804. doi: 10.1097/EDE.0b013e3181577654. - DOI - PubMed
    1. Titus J.M., Cragg A., Alden P., Alexander J., Manunga J., Stephenson E., Skeik N., Sullivan T. A prospective randomized comparison of contralateral snare versus retrograde gate cannulation in endovascular aneurysm repair. J. Vasc. Surg. 2017;66:387–391. doi: 10.1016/j.jvs.2017.01.038. - DOI - PubMed
    1. Wolf Y.G., Tillich M., Lee W., Rubin G.D., Fogarty T.J., Zarins C.K. Impact of aortoiliac tortuosity on endovascular repair of abdominal aortic aneurysms: Evaluation of 3D computer-based assessment. J. Vasc. Surg. 2001;34:594–599. doi: 10.1067/mva.2001.118586. - DOI - PubMed

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