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Eur J Cardiothorac Surg 2002;22:316-318
© 2002 Elsevier Science NL

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In situ introducer sheath dilatation for complex aortic access

Department for Cardio-vascular Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, CH-1011 Lausanne, Switzerland

Received 17 February 2002; received in revised form 19 April 2002; accepted 23 April 2002.

* Corresponding author. Tel.: +41-21-314-2280; fax: +41-21-314-2278
e-mail: ludwig.von-segesser{at}chuv.hospvd.ch

Aortic access problems due to diseased or small peripheral vessels are a major issue in endovascular aneurysm repair (EVAR). In the emergency setting, like aortic rupture after blunt trauma, or in patients with a hostile abdomen, a more proximal access to the aorta is not a pleasant perspective. We developed in situ introducer sheath dilatation as a bail-out technique for patients with difficult aortic access under various circumstances including EVAR, intra-aortic balloon pump insertion and cannulation for perfusion. The method described allows to increase the access vessel diameter by 50% (from 6 to 9 mm) or the luminal circumference from 18 to 27 F. We have used this technique in five patients without complication, very much in contrast to the traditionally practiced ‘forced device insertion’.

Key Words: Endovascular aneurysm repair • Aortic access • Intra-aortic balloon pump • Cannulation • Perfusion • Cardiopulmonary bypass

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