The Skewer Technique for Stentgraft Delivery in the Aortic Arch: Advancing the Dilatator in The Innominate Artery Over a Right Femoro-Brachial Through-And-Through Wire

Hamwi, Tarek; Tsilimparis, Nikolaos; Stana, Jan; Fenelli, Cecilia; Benfor, Bright und Prendes, Carlota F. (2022): The Skewer Technique for Stentgraft Delivery in the Aortic Arch: Advancing the Dilatator in The Innominate Artery Over a Right Femoro-Brachial Through-And-Through Wire. In: Annals of Vascular Surgery, Bd. 80, 397.e397-397.e6

Abstract

Background: Thoracic endovascular aortic repair (TEVAR) is the preferred treatment for different aortic pathologies, because it has reduced mortality and morbidity rates. However, TEVAR is not feasible in all cases due to aortic angulations, the hemodynamics of the aortic arch and narrow or tortuous iliofemoral access. Therefore, different adjuvant techniques, such as iliac percutaneous transluminal angioplasty, iliathrough-and-through guidewires and external transapical guidewires have been previously reported. Herein we describe the Skewer Technique for successful TEVAR delivery, through a right-brachial-femoral through-and-through guidewire and advancement of the delivery system into the innominate artery. Methods: A 38-year-old male presented with a symptomatic 11.5cm thoracic aneurysm with involvement of the left-subclavian artery ostium. The patient underwent left carotid-subclavian bypass and a TEVAR. Due to the huge size of the aneurysm a left-brachial-right femoral artery through-and-through guidewire was established. However, the achievement of a stable position for the deployment of the stentgraft was not possible. Eventually, the exclusion of the aneurysm was done with a right brachio-femoral through-and-through wire, inserting the proximal part of the delivery system into the innominate artery. Conclusions: The use of adjuvant techniques such as a through-and-through right brachialfemoral guidewire with advancement of the endograft delivery system in the innominate artery (Skewer Technique) represents a useful alternative option in cases where the angulations of the aortic arch impede the deployment of the stent graft using conventional techniques.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0890-5096
• Sprache: Englisch