The "Destino guided BEVAR" to catheterize downward branches from a femoral access: technical note and case report.

OBJECTIVE: To report the Destino guided BEVAR (De-BEVAR) approach as a valid alternative to catheterization downward branches in complex aortic arch/descending thoracic anatomies.

TECHNIQUE & CASE REPORT: A 53 years-old woman with Marfan syndrome underwent a TAAA repair for a type III dissecting aneurysm. A custom repair with an endograft having 3 fenestrations (for renal arteries and superior mesenteric artery) and one branch for the celiac trunk was planned. The right axillary artery was chronically occluded; the left subclavian artery (LSA) was aneurysmatic. The catheterization of the celiac trunk branch was demanding but ultimately a bare stent was used as a bridging component between the graft and the target vessel, for spinal cord preconditioning. At the 2 month CTA, when planning the relining of the bare metal stent, a 1 cm increase in diameter of the LSA aneurysm was documented and therefore a De-BEVAR was planned. This approach consists of branch catheterization via femoral access using the Destino steerable guiding sheath inside which, after bending, a smaller Cook Flexor is placed to easily deliver the stent, while maintaining stability.

CONCLUSION: The De-BEVAR is a reproducible and effective alternative to the classic catheterization of side branches via brachial/axillary access allowing their completion from a femoral access.