Antegrade transapical branch deployment for endovascular aortic-arch repair by in situ fenestration

Abstract A 76-year-old man presented with an aortic arch aneurysm and was considered a candidate for endovascular aortic arch repair by in situ fenestration. Alternative access routes were explored because of atherosclerotic disease of the descending aorta and bilateral carotid arteries. Transapical deployment of both an aortic and a branched stent grafts was successfully conducted without cerebral complications. The transapical access might have the potential to reduce the risks of complications related to large bore-sheath insertion to the carotid arteries.

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Technical Aspects of Branched Thoracic Arch Graft Implantation for Aortic Arch Pathologies

Journal of Endovascular Therapy ◽

10.1177/1526602820925443 ◽

2020 ◽

Vol 27 (5) ◽

pp. 792-800 ◽

Cited By ~ 1

Author(s):

Konstantinos Spanos ◽

Giuseppe Panuccio ◽

Fiona Rohlffs ◽

Franziska Heidemann ◽

Nikolaos Tsilimparis ◽

...

Keyword(s):

Aortic Arch ◽

Innominate Artery ◽

Distal Segment ◽

Implantation Technique ◽

Sinotubular Junction ◽

Descending Aorta ◽

Type A Aortic Dissection ◽

Aortic Arch Repair ◽

High Level ◽

Arch Aneurysm

Purpose: To describe the implantation steps and tips and tricks for the Inner Branch Arch Endograft designed to treat aortic arch aneurysm and chronic type A aortic dissection. Technique: Anatomical suitability criteria should be met in order to use this device. The proximal segment of the graft lands in the ascending aorta distally to the sinotubular junction and the distal segment lands in the descending aorta. The device includes 2 inner branches; the proximal branch is used for a connection to the innominate artery (positioned slightly posterior at 12:30 o’clock), while the second branch is positioned slightly anterior at 11:30 o’clock and is used as a connection to the left common carotid artery. Access, implantation technique, deployment of the device, and catheterization of the branches are described thoroughly. Conclusion: This Inner Branch Arch Endograft is an appealing alternative to treat aortic arch pathology, especially in patients unsuitable for open repair. Nevertheless, complex aortic arch repair is associated with a learning curve. Meticulous preoperative planning and a high level of concentration intraoperatively are mandatory.

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Accelerated fatigue study of in situ fenestrated endovascular stent grafts deployed inside the 3D phantom of a patient's aortic arch aneurysm

Frontiers in Bioengineering and Biotechnology ◽

10.3389/conf.fbioe.2016.01.01217 ◽

2016 ◽

Vol 4 ◽

Author(s):

Yao Tong ◽

Tse Leonard ◽

Tan Kongteng ◽

Marks Steven ◽

Robertson Ian ◽

...

Keyword(s):

Aortic Arch ◽

Aortic Arch Aneurysm ◽

Endovascular Stent ◽

Stent Grafts ◽

Arch Aneurysm

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A hybrid approach to right-sided aortic arch aneurysm using bilateral carotid to subclavian bypass with a customized fenestrated thoracic endovascular aortic repair device

The Arab Journal of Interventional Radiology ◽

10.4103/ajir.ajir_21_17 ◽

2018 ◽

Vol 2 (1) ◽

pp. 26

Author(s):

VictoriaA Burrows ◽

Siuchan Sookhoo

Keyword(s):

Aortic Arch ◽

Hybrid Approach ◽

Thoracic Endovascular Aortic Repair ◽

Aortic Arch Aneurysm ◽

Endovascular Aortic Repair ◽

Aortic Repair ◽

Bilateral Carotid ◽

Arch Aneurysm

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Hybrid Procedure with Debranching from the Descending Aorta for Aortic Arch Aneurysm after Previous Open Repair

Annals of Vascular Surgery ◽

10.1016/j.avsg.2016.05.131 ◽

2017 ◽

Vol 38 ◽

pp. 319.e7-319.e10 ◽

Cited By ~ 1

Author(s):

Juergen Zanow ◽

Martin Breuer ◽

Eric Lopatta ◽

Christoph Schelenz ◽

Utz Settmacher

Keyword(s):

Aortic Arch ◽

Open Repair ◽

Hybrid Procedure ◽

Aortic Arch Aneurysm ◽

Descending Aorta ◽

Arch Aneurysm

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Transapical Access for Antegrade Catheterization of the Inner Branches of an Arch Stent-Graft Deployed Distal to an Ascending Arch Stent-Graft

Journal of Endovascular Therapy ◽

10.1177/1526602818792042 ◽

2018 ◽

Vol 25 (5) ◽

pp. 542-546 ◽

Cited By ~ 3

Author(s):

Yuk Law ◽

Tilo Kölbel ◽

Johannes Schirmer ◽

Shadi Aleed ◽

John Mogensen ◽

...

Keyword(s):

Stent Graft ◽

Aortic Rupture ◽

Past History ◽

Type I ◽

Stent Grafts ◽

Landing Zone ◽

Aortic Repair ◽

History Of ◽

Arch Aneurysm ◽

Transapical Access

Propose: To describe a technique for antegrade cannulation and bridging of the supra-aortic branches through a transapical access in the treatment of an arch aneurysm using combined ascending and branched arch stent-grafts. Technique: An 81-year-old man with a past history of open infrarenal aortic repair, emergent endovascular aortic repair for thoracic aortic rupture, and later perivisceral 4-vessel branched endovascular repair of type I thoracoabdominal aneurysm presented for repair of a concomitant 7.5-cm arch aneurysm. Because of a 44-mm ascending aorta, a tapered 50/44-mm ascending stent-graft was delivered through a transapical access to establish an adequate landing zone before implantation of a 46-mm inner branched arch device via a transfemoral route. Innominate and left subclavian arteries were antegradely cannulated and bridged through the existing transapical path. Conclusion: Our case demonstrates the feasibility of transapical access for cannulation of an arch branched device, while introducing the theoretical possibility of completing the entire procedure through a transapical access.

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