Transseptal Guidewire Stabilization to Facilitate Endograft Delivery During Thoracic Endovascular Aortic Repair of a Giant Tortuous Thoracic Aortic Aneurysm
Abstract
Objective: To describe transseptal guidewire stabilization to facilitate endograft delivery into the aortic arch during thoracic endovascular aortic repair (TEVAR) when aortic tortuosity impedes delivery system advancement.
Key steps: The key steps to the procedure are as follows: the physician modifies the arch endograft, the patient is given general anesthesia, ultrasonography-guided percutaneous access is obtained, septal puncture is performed, a Mullins-type sheath is advanced into the ascending aorta over the balloon-tipped catheter, a coaxial hydrophilic guidewire is exteriorized from the right femoral artery, a transseptal snare traps the Lunderquist guidewire entering the transseptal sheath from the aorta, traction is applied, the endograft delivery system is advanced into position, and thoracic endovascular aortic repair is subsequently completed as usual.
Potential pitfalls: Injury to the mitral valve and atrial septum can be limited by keeping the transseptal sheath advanced well beyond the mitral valve when traction is applied. Hardware manipulation in the aortic arch is minimized to prevent embolic stroke.
Take-home messages: Transseptal guidewire stabilization during thoracic endovascular aortic repair facilitates endograft delivery into the aortic arch when impeded by aortic tortuosity. Keeping the transseptal sheath advanced beyond the mitral valve limits cardiac structural injury.
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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