A review on the use of steerable sheaths in complex endovascular aortic repair

Abstract

Complex aortic aneurysms are now more commonly treated endovascularly, and often require a fenestrated-branched endovascular aneurysm repair. The use of steerable sheaths can improve the technical success rate in catheterisation of target visceral vessels and reduce the surgical risks associated with these complicated procedures. There are several commercially available steerable sheaths in the market, but similar devices can be homemade using different endovascular instruments. Steerable sheaths allow catheterisation of downward orientated branches more easily through a transfemoral approach. The risks associated with a traditional upper extremity access can be minimalised. They are also described in the use of several other situations during endovascular aortic repairs. Limitations to this technique are the availability of the device, the stability of the sheath curvature, the difficulty to deliver instruments in a tight curve and the associated complications if large sheaths are used. Steerable sheaths can be used as a primary intent when challenging anatomy is anticipated or as an adjunct when standard procedures are not successful.