TABLE 1.
Recommended Report Content for Transcaval Planning, With an Example
| Feature | Example Value and Detail |
|---|---|
| Recommendation | Favorable (no high-risk features) Feasible (having features that increase difficulty or risk) Unfavorable (having features that contraindicate or significantly increase risk and difficulty) |
| Basis for recommendation | Detail such as “having no high-risk features” or “planned on noncontrast Computed Tomography” |
| Target entry site lumbar vertebra | L3.0 = middle of lumbar vertebra; L3.5 = midway between L3 and L4; see text for a further description of this nomenclature |
| Projection angles | 30° RAO and 60° LAO; these are the angles with regard to horizontal or vertical with the centers of the IVC and aorta at the crossing target |
| Interposed and nearby structures | Example: bowel anterior |
| Aortic lumen diameter (+3/0/−3 cm) | Above 16 mm/at target 15 mm/below 14 mm to help select bailout covered stent device |
| Target distance below renal artery | 25 mm (to aid in planning closure and covered stent) |
| Target distance above aortoiliac bifurcation | 65 mm (to aid in planning closure and covered stent) |
| Working sheath distance to target | 25 cm from RFV puncture site to aortic entry along theoretical vascular centerline |
| Covered-stent bailout limb access and size | L 4.5 mm/R 4.0 mm minimum lumen dimension of L and R iliofemoral arteries to guide arterial access and covered stent bailout |
| Mesenteric arteries | Celiac and SMA patent; to determine risk of mesenteric ischemia if inferior mesenteric artery becomes occluded |
| Other caveats | Calcium is mostly anterior at the target; compression fractures cause L3 to L4 to correspond to iliac crests; leftward aorta 15°; SMA 80% ostial stenosis; accessory L renal artery 10 mm superior to target; patient rotated 10° leftward on Computed Tomography table. These are examples of miscellaneous comments important to the operator. |
IVC = inferior vena cava; L = left; LAO = left anterior oblique; R = right; RAO = right anterior oblique; RFV = right femoral vein; SMA = superior mesenteric artery.