Endovascular septal fenestration using a radiofrequency wire to salvage inadvertent false lumen deployment of a frozen elephant trunk stent graft

Abstract

We report a case of a frozen elephant trunk arch repair, where the stent graft was unintentionally placed into the false lumen. Postoperative imaging demonstrated an enlarged false lumen with no thoracic aorta fenestrations that could be traversed to place another thoracic endovascular aortic repair endograft into the true lumen. An atraumatic radiofrequency wire (PowerWire, Baylis Medical, Montreal, Quebec, Canada) was used to create a new septal fenestration, enabling thoracic endovascular aortic repair endograft extension into the thoracic true lumen. This novel use of a radiofrequency wire can enable safe and controlled endovascular septal fenestration even in chronic dissections to redirect flow into the true lumen.

Snare-assisted thoracic endovascular aortic repair for redirection of a false lumen elephant trunk

“…9 Lastly, one report described a more controlled method of creating a trans-septal fenestration using a combination of the TourGuide (Medtronic, Santa Rosa, Calif) articulating sheath and the radiofrequency PowerWire (Baylis Medical), followed by balloon dilation of the fenestration to allow placement of a bridging endograft. 10 In our patient, because diagnostic angiography had demonstrated multiple large fenestrations close to the false lumen elephant trunk, we did not think it was necessary to pursue creation of a new fenestration. Before cannulation of this fenestration, confirmation by IVUS to ensure a continuous path throughout the true lumen beginning at the femoral access point was critical in avoiding potential compromise of visceral and renal vessels.…”

“… 9 Lastly, one report described a more controlled method of creating a trans-septal fenestration using a combination of the TourGuide (Medtronic, Santa Rosa, Calif) articulating sheath and the radiofrequency PowerWire (Baylis Medical), followed by balloon dilation of the fenestration to allow placement of a bridging endograft. 10 …”

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

“… 3 In such cases, emergent fenestration distal to the endograft can restore flow to the TL and be lifesaving. 4 Endovascular fenestration is preferred over open surgical fenestration or endograft explantation given the lower operative morbidity rates. 4 …”

“… 4 Endovascular fenestration is preferred over open surgical fenestration or endograft explantation given the lower operative morbidity rates. 4 …”

Detection of inadvertent passage of guide wire into the false lumen during thoracic endovascular aortic repair of Type B aortic dissection by transesophageal echocardiography

“…False lumen endovascular stent placement is a devastating complication of TEVAR. It may lead to true lumen compression with resultant mesenteric, renal, and lower extremity malperfusion as well as extending the dissection, which is often fatal [ 6 ]. Rapid intervention and intraoperative detection of such event is paramount to prevent serious complications.…”