To ensure a central DSA and marking of the origin of the subclavian artery and the truncus coeliacus, insertion of a 6F sheath over the exposed left brachial artery using Seldinger technique. Insertion of a Terumo® wire through the sheath. Local administration of 2000 IU heparin-saline solution.
Note:
Puncture or probing of the brachial artery is not absolutely necessary if the anatomical boundary markers for the origin of the subclavian artery and the truncus coeliacus can be clearly determined following a DSA via the groin or iliac access.
After insertion of the relatively rigid endoluminal aortic prosthesis together with the delivery system, however, the markings may occasionally deviate from the actual position of the markers. In cases of narrow distances between the prosthesis end and the subclavian artery or truncus coeliacus, as in the video example, a repeat DSA is required before releasing the prosthesis body, so that the lumina of the aforementioned vessels are not inadvertently occluded.
