The “Lasso-Technique”: A Maneuver to Stabilize a Steerable Sheath for Transfemoral Access to Antegrade Branches in Branched Endovascular Aortic Repair—A Report of Four Cases

The presented approach is an easily accomplished maneuver enabling transfemoral implantation of bridging stents in thoracoabdominal aortic stent grafts. Compared to similar techniques, it requires sheaths with smaller diameters (7F and 4F vs 12F) yet bilateral femoral artery puncture. It allows for hooking the sheath in the target branch, offering increased stability while being safer compared to upper extremity access approaches.Clinical ImpactThe "Lasso-Technique" is a practical and reproducible method for accessing branches during branched endovascular aortic repair (b-EVAR) procedures. The technique eliminates the need for brachial access, potentially reducing radiation exposure and complications associated with upper-extremity access. It utilizes readily available tools and small-caliber sheaths, making it easy for most vascular centers to adopt without requiring additional resources. Its straightforward design may help streamline workflows while enhancing patient safety.