Revisiting the brachiofemoral through-and-through wire technique for hybrid arch repair with a problematic elephant trunk

Kawajiri, Hidetake; Oka, Kazutaka; Yamasaki, Takuma; Koh, Eisei

doi:10.1016/j.jtcvs.2015.04.006

Cited by 4 publications

(2 citation statements)

References 5 publications

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“…Severe angulation along the length of the aorta and the iliac arterial segments can hamper the tracking and delivery of endovascular devices over stiff guidewires during EVAR or thoracic EVAR, 4 , 5 including failure to obtain retrograde wire access when a frozen elephant trunk repair has been undertaken, 6 often creating anatomical constraints beyond the instructions for use of the proposed endoprosthesis, 7 and in such cases even strategies such as the use of double stiff wires do not work. Thus pullthrough wires have been applied for thoracic and aorto-iliac interventions, 4 , 5 and femorofemoral pullthrough configurations 8 have also been successfully applied, precluding the need for brachial access.…”

Section: Discussionmentioning

confidence: 99%

Quantifying the Functional Stiffness of Pullthrough Wires Used for Endovascular Aneurysm Repairs Using Comparative Tension Dynamometry

Chaudhuri

Heim

Chakfe³

2022

EJVES Vascular Forum

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Section: Discussionmentioning

confidence: 99%

Quantifying the Functional Stiffness of Pullthrough Wires Used for Endovascular Aneurysm Repairs Using Comparative Tension Dynamometry

Chaudhuri

Heim

Chakfe³

2022

EJVES Vascular Forum

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“…In fact, the use of a through-and-through or body floss wire, might improve stent graft stabilization in acutely angulated aortic arches. 7,8 Such a body floss wire can be obtained by bringing down, and subsequently out the femoral artery, a stiff guidewire using a snare or lasso. Through a long catheter from apex to groin, the stiff wire can be safely forwarded to allow for gentle pull upon introduction of the stent graft to prevent the stent graft from touching the outer aortic arch curvature, thus also decreasing the risk of distal embolization from debris at the outer curvature.…”

Section: Discussionmentioning

confidence: 99%

A challenging double bubble thoracic aortic and proximal subclavian aneurysm treated via transapical access

Beaufort

Heuvel

Heijmen

2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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This case report describes a patient with a distal aortic arch and left subclavian artery aneurysm who was considered unsuitable for open surgical repair because of comorbidities and previous bypass surgery. Inadequate peripheral access precluded standard transfemoral thoracic endovascular aortic repair. Nonetheless, successful endovascular repair was possible via transapical access using the new Gore cTAG deployment mechanism, which allowed precise antegrade stent graft deployment in a short proximal neck. (J Vasc Surg Cases and Innovative Techniques 2020;6:80-3.)

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Estimating the “Pull” on a Pullthrough Wire: A Pilot Study

Chaudhuri

Heim

Chakfe³

2021

EJVES Vascular Forum

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Objective Pullthrough/body floss wires are used to track endovascular devices across tortuous aorto-iliac anatomy encountered during endovascular repair of abdominal or thoracic aortic aneurysms. The tension imparted on such wires is arbitrary and has never been quantified. This pilot study attempted to quantify the tension used to stiffen the floppy hydrophilic wires typically used in such a scenario. Methods Two linked experiments were undertaken, the first by tasking 13 blinded vascular surgeons (eight male, five female; mean age 36 ± 11 years, including nine trainees) with pulling a long floppy hydrophilic wire (Radifocus Guidewire M Stiff, Terumo UK, Bagshot, Surrey, UK) attached at the other end to a horizontally configured industrial scale (HDN-N Hanging Scale, Kern & Sohn GmbH, Balingen, Germany), to simulate what they individually felt was an “appropriate” tension; the second by using the derived average tensioning force to set up a pullthrough wire within a rigid life like aorto-iliac model to assess whether a test device (16F Sentrant Introducer Sheath, Medtronic Limited, Watford, UK) could be delivered over such a tensioned wire in both brachiofemoral and femorofemoral configurations. Results The mean tension exerted by the group on the wire was 38.3 ± 14.8 N (equivalent to 3.9 kgf). Pullthrough wire tensioning was undertaken by fixing one end and applying a 3.9 kg weight at the other. The test device was successfully deployed into the infrarenal aortic position and also across the aortic bifurcation, via brachiofemoral and femorofemoral pullthrough configurations, respectively. Conclusion Successful test device deliveries suggest that a minimum tension equivalent to almost 4 kgf applied to a floppy wire can provide “stiffeningˮ to allow device tracking across tortuous aorto-iliac anatomy. More studies are needed to ascertain whether lower tensions can be applied; these results may help provide a platform for other such studies depending on configuration, aortic geometry, and device or wire/tension characteristics.

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Revisiting the brachiofemoral through-and-through wire technique for hybrid arch repair with a problematic elephant trunk

Cited by 4 publications

References 5 publications

Quantifying the Functional Stiffness of Pullthrough Wires Used for Endovascular Aneurysm Repairs Using Comparative Tension Dynamometry

Quantifying the Functional Stiffness of Pullthrough Wires Used for Endovascular Aneurysm Repairs Using Comparative Tension Dynamometry

A challenging double bubble thoracic aortic and proximal subclavian aneurysm treated via transapical access

Estimating the “Pull” on a Pullthrough Wire: A Pilot Study

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