Antegrade thoracic endovascular aortic repair using an ascending aortofemoral through-and-through wire technique for a severely tortuous aorta associated with rickets

Abstract

BackgroundSevere aortic tortuosity of the access route often prevents successful complete exclusion of an aneurysm in thoracic endovascular aortic repair (TEVAR).Case presentationWe performed antegrade TEVAR on a 79-year-old man with right hemiparesis. We deployed the stent graft from the ascending aorta with a tube graft conduit to treat a descending thoracic aortic aneurysm associated with rickets and multiple comorbidities. Although the application of a ministernotomy diminished the potential advantages of endovascular treatment in view of less invasive surgery, antegrade TEVAR using an ascending aortofemoral through-and-through wire technique was a good option in this patient because a conventional retrograde approach was not feasible due to his severely tortuous aorta.ConclusionsTo avoid device-related complications, it is crucial to make a prudent preoperative decision on a patient-by-patient basis, taking into account the appropriate access site, adjuvant guidewire technique, and adjunctive surgical interventions.

Trans-sternotomy, snare-assisted thoracic endovascular aortic repair for redirection of a migrated elephant trunk

“… 10 , 11 Antegrade body floss access will usually be through the right brachial artery, then the left common carotid artery or left subclavian artery. 12 In patients with severe supra-aortic calcification, the ascending aorta can be accessed through a transapical approach, often used for transcatheter aortic valve replacement or with a transseptal sheath and snare-pull down of the delivery system. 4 , 11 Because these approaches have been associated with valve regurgitation, an alternative is to use a graft conduit.…”

“…This technique is also indicated for TEVAR placement in a tortuous, elongated thoracic aorta such as rickets and angulated arches. 12 Using a catheter over the wire or EN snare can mitigate trauma to the artery's ostium from the body floss on tension. 15 …”