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A new shunting concept to prevent lower limb ischemia/reperfusion injury in prolonged fenestrated stent-graft procedures.

AIM
Complex endovascular procedures to treat thoracoabdominal aortic aneurysms (TAAA) can be time consuming and therefore comprise the risk of lower limb ischemia with subsequent reperfusion injury and compartment syndrome. Aim of this study was to evaluate a new protective method to prevent these postoperative problems.


METHODS
In order to maintain blood perfusion to both legs during prolonged endovascular aortic procedures we developed a shunting technique with two additional 7 French (Fr) sheaths in both superficial femoral arteries. We evaluated the perfusion technique in 5 patients with fenestrated endovascular aortic aneurysms repair (FEVAR). First, we measured the flow in the 7 Fr sheaths; second, we clinically controlled the lower limb for developing compartment syndrome. Third we measured creatinine kinase (CK) as marker for postoperative muscular damage.


RESULTS
In 5 male patients (median age 77, range 59-80 years) undergoing endovascular TAAA repair, the perfusion technique was feasible. The median flow per catheter was 102 mL/min (range 61-156.5 mL/min) and monophasic with a mean arterial blood pressure of 71 mmHg (range 56-82 mmHg). No patient developed a compartment syndrome. The CK levels were only lightly elevated.


CONCLUSION
This simple perfusion technique allows adequate lower limb perfusion during prolonged complex endovascular aortic procedures.