Total Endovascular Repair of an Aortic Arch Aneurysm Using an Externalized Transseptal Guidewire Technique

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

“…Further transcardiac approaches, such as transvenous-transseptal or a transapical through-and-through wire, have been recently described. 11–13 Kölbel et al 11 suggested the use of an externalized transseptal guidewire technique to facilitate guidewire stabilization and stent-graft passage in the aortic arch, whereas Joseph et al 14 used a transseptal snare for applying tension to the retrograde inserted stiff wire. Both techniques may be associated with adverse cardiac events, similar to transcardiac aortic valve implantation.…”

Commentary: Transcardiac Access to the Ascending Aorta and Beyond

“…More recently, Joseph et al 11,12 described how ascending aortic access obtained through a long transseptal sheath kept steady by a taut indwelling guidewire can be used to facilitate endograft passage in the aortic arch by pull-down with a snare, or to embolize type I proximal endoleak in a bird-beaked aortic arch endograft. Other workers have also reported using the transseptal approach successfully to perform similar interventions 13,14 or for selective coronary angiography, 15,16 attesting to the feasibility and reproducibility of the transseptal technique.…”

Commentary: Extending the Boundaries of Total Endovascular Aortic Arch Repair

“…2 Another method for achieving through and through wire access from the LV to the femoral artery is the transseptal approach, as previously described by the Hamburg group 3 and our group. 4 An additional benefit of the transapical approach is the treatment of complex dissections of the arch with true and false lumen perfusion of the supra-aortic trunks (SAT). Advancing a wire from the LV directly into the true lumen is very valuable; indeed, access to the true lumen from the femoral arteries can sometimes be very challenging and time consuming.…”

“…2 Another method for achieving through and through wire access from the LV to the femoral artery is the transseptal approach, as previously described by the Hamburg group 3 and our group. 4…”