The Ascending Aorta as an Exit Site for a Through-and-Through Wire in TEVAR

Brunkwall, Silke; Ahmad, Wael; Mylonas, Spyridon N.; Sharkawy, Mohamed Ibrahim; Wippermann, Jens; Brunkwall, Jan

doi:10.1177/1526602815607441

Cited by 5 publications

(4 citation statements)

References 15 publications

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“…Most of these initially had received a mechanical artificial aortic valve. In many of these cases market-available devices might not be suitable or available in emergency conditions, and until now mechanical aortic valves have given contraindication to ETAG [4].…”

Section: Discussionmentioning

confidence: 99%

Externalized transapical guidewire technique after artificial aortic valve replacement during complete endovascular aortic arch repair.

Jędrzejczak¹,

Rynio²,

Lewandowski³

et al. 2020

Videosurgery and Other Miniinvasive Techniques

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An externalized transapical guidewire (ETAG) technique has been used for safe delivery of high-profile devices through a tortuous aorta to zone 0, which is currently precluded after mechanical artificial aortic valve replacement (AVR). The aim of the study was to report one center’s experience (based on 3 cases) of a unique modification to the ETAG technique used for the first time during total endovascular aortic arch repair after AVR. This report contains technical notes regarding a new method of steering the guidewire from the apex inside the artificial aortic valve during total endovascular aortic arch repair after AVR and the details crucial in preparation for this mini-invasive procedure. As a conclusion, the ETAG technique could be performed after mechanical AVR with active positioning of the guidewire carried out under the control of transesophageal echocardiography.

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Section: Discussionmentioning

confidence: 99%

Externalized transapical guidewire technique after artificial aortic valve replacement during complete endovascular aortic arch repair.

Jędrzejczak¹,

Rynio²,

Lewandowski³

et al. 2020

Videosurgery and Other Miniinvasive Techniques

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“…using coaxial sheaths, transapical access, transapical-femoro “body floss” wire. 21–25 Adopting these alternative strategies for proximal advancement of the endograft into the aortic arch is, however, associated with several concerns about the safety of these approaches. 26 Early or late complications, such as an apex or ascending aortic bleeding, coronary artery lesions and pseudoaneurysms can occur.…”

Section: Discussionmentioning

confidence: 99%

Single-center mid-term experience with chimney-graft technique for the preservation of flow to the supra-aortic branches

et al. 2017

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Objectives To investigate the feasibility and the mid-term outcomes of the chimney-graft technique for the revascularization of supra-aortic branches in patients with thoracic aortic pathologies involving the aortic arch. Methods A retrospective analysis of a prospectively maintained database between January 2010 and July 2016 was performed. Primary endpoints were 30-day and overall mortality. Secondary endpoints were technical success, target vessel patency, stroke/transitory ischemic attack and type I/III endoleak rate. Results A total of 30 patients (80% male, median age 70.0 years) were treated using the chimney-graft technique for the supra-aortic branches. The indication was a degenerative aneurysm in nine patients (32%) and a type B Stanford aortic dissection and a penetrating aortic ulcer in the descending aorta in seven patients (23%), respectively. In six patients (20.0%), the indication was an type Ia endoleak after previous endovascular thoracic repair, whereas a pseudoaneurysm after previous open repair of the descending aorta was the indication in one patient (3%). Twenty-three patients (77%) were treated electively, five (17%) emergently and two (7%) urgently because of free rupture. Technical success was achieved in 90% of patients. The 30-day/in-hospital mortality was 17% (5/30). A retrograde dissection was presented in five patients. Four patients experienced a cerebrovascular event. Eight patients had type Ia endoleak and 10 had type II. During the median follow-up of 16 months (range: 0-56), four further patients died: one in respiratory insufficiency, one due to a ruptured abdominal aortic aneurysm, one in meningitis and the last one for unknown reason. The chimney-graft patency was 100%. According to the Kaplan-Meier curve, the estimated survival at one year was 66 ± 9%. Conclusions The chimney-graft technique, despite a technically demanding strategy, is a useful tool as bailout procedure in our armamentarium for high-risk patients, unsuitable for open or hybrid repair.

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“…The use of stiff “buddy” wires and the introduction of a coaxial sheath should be performed primarily to straighten an excessively tortuous aorta, but delivery of the stent graft can be difficult. The through-and-through wire technique, which pulls both sides of an externalized guidewire with adequate tension and straightens the severely tortuous aorta, is a powerful means of delivering stent grafts [2]. The through-and-through wire technique from the right brachial artery to the femoral artery was not feasible in the present case because the right brachiocephalic artery was severely tortuous [3].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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The Ascending Aorta as an Exit Site for a Through-and-Through Wire in TEVAR

Abstract: A trans-ascending aorta through-and-through guidewire is a feasible adjunct that can be added to the endovascular armamentarium when transcardiac or transbrachial approaches are impossible or ineffective.

Cited by 5 publications

References 15 publications

Externalized transapical guidewire technique after artificial aortic valve replacement during complete endovascular aortic arch repair.

Externalized transapical guidewire technique after artificial aortic valve replacement during complete endovascular aortic arch repair.

Single-center mid-term experience with chimney-graft technique for the preservation of flow to the supra-aortic branches

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

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