Silke Brunkwall1, Wael Ahmad2, Spyridon Mylonas2, Mohamed Sharkawy3, Jens Wippermann4, Jan Brunkwall2. 1. Department of Vascular and Endovascular Surgery, University of Cologne, Germany silke.brunkwall@uk-koeln.de. 2. Department of Vascular and Endovascular Surgery, University of Cologne, Germany. 3. Department of Surgery, Kasr El Aini Hospital, Faculty of Medicine, Cairo, Egypt. 4. Department of Cardiovascular Surgery, University of Cologne, Germany.
Abstract
PURPOSE: To describe a technique for trans-ascending aorta through-and-through guidewire placement for thoracic endograft advancement and deployment. CASE REPORT: A 55-year-old man presented with a symptomatic pseudoaneurysm of the distal aortic arch after aortic coarctation open repair. He had also undergone mechanical aortic valve replacement. Planned were a left-sided carotid-subclavian bypass and a thoracic endovascular aortic repair with a chimney graft to the left common carotid artery. After carotid-subclavian bypass, efforts to retrograde cannulate the aortic arch and advance the thoracic endograft were unsuccessful. Because of the mechanical heart valve, no transapical approach could be used. Access to the ascending aorta was gained through a midline sternotomy. A through-and-through wire was positioned from the ascending aorta to femoral artery, which provided the required stability for advancement of the thoracic endograft. Six-month computed tomography documented patent endografts and carotid-subclavian bypass and no evidence of endoleak. CONCLUSION: 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.
PURPOSE: To describe a technique for trans-ascending aorta through-and-through guidewire placement for thoracic endograft advancement and deployment. CASE REPORT: A 55-year-old man presented with a symptomatic pseudoaneurysm of the distal aortic arch after aortic coarctation open repair. He had also undergone mechanical aortic valve replacement. Planned were a left-sided carotid-subclavian bypass and a thoracic endovascular aortic repair with a chimney graft to the left common carotid artery. After carotid-subclavian bypass, efforts to retrograde cannulate the aortic arch and advance the thoracic endograft were unsuccessful. Because of the mechanical heart valve, no transapical approach could be used. Access to the ascending aorta was gained through a midline sternotomy. A through-and-through wire was positioned from the ascending aorta to femoral artery, which provided the required stability for advancement of the thoracic endograft. Six-month computed tomography documented patent endografts and carotid-subclavian bypass and no evidence of endoleak. CONCLUSION: 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.
Authors: Tomasz Jędrzejczak; Paweł Rynio; Maciej Lewandowski; Arkadiusz Kazimierczak Journal: Wideochir Inne Tech Maloinwazyjne Date: 2020-03-27 Impact factor: 1.195