Techniques for precise thoracic endograft placement.

Precise endograft placement in the thoracic aorta is challenging due to the special local anatomy and unique hemodynamic blood flow. We are employing many techniques together to launch the endograft precisely to the target location: various debranching techniques to extend the proximal landing zone, magnified imaging with full exposition of the supra-arch branches and the proximal landing area to achieve a clear and accurate view, screen markers of the landing target for guidance of deployment, 1-2 cm proximally to the cranial landing marker before launching in case of any displacement, steady deployment of the endograft in hypotensive status or within the temporary heart asystole period induced by intravenous adenosine administration. If a balloon angioplasty or a proximal cuff is inevitable, the abovementioned techniques should be repeated. Our single center results have proved the combined techniques for precise thoracic endograft placement reliable, effective, simple and practical.