Angiographic Approach to the Difficult Aortic Arch: A New Technique for Transfemoral Cerebral Angiography in the Aged

A Morphometric Study on Cadaveric Aortic Arch and Its Major Branches in 25 Korean Adults : The Perspective of Endovascular Surgery

“…The selection may be different according to the preference of surgeons; however, we have conventionally used the number 5 French, J type catheter in adults. Considering the flexion and angle of the blood vessels and the different types that may be selected, the Simons type may prove to be more applicable when the left common carotid artery has an acute angle 18) . Examining the inside of the blood vessels revealed that ridges formed by fibrous tissues were present between the three major branches.…”

Initial experience with a multiple parallel guidewire support system for complex tortuous aortic arch navigation and great vessel catheterization: technical note

“…Classification of the elongation of the aortic arch (Types I-III) correlates with increasing difficulty in great vessel cannulation and an increased risk of complications when using femoral artery access. [1][2][3][4] In addition to tortuosity, these vessels are also commonly atherosclerotic and calcified and therefore not compliant. Moreover, positive forces on guidewires to gain distal access translate into pushback or retrograde movement of guiding catheters and herniation into the arch.…”

“…Anatomical variations in the aortic arch itself, such as the so-called bovine arch, also complicate access to the great vessels. [1][2][3][4] Access in these cases takes longer and requires greater efforts with increasingly higher risk manipulation. These arches also frequently have atherosclerotic plaque on walls and vessel ostia, posing a markedly higher risk of intraprocedural embolic complications.…”

“…These arches also frequently have atherosclerotic plaque on walls and vessel ostia, posing a markedly higher risk of intraprocedural embolic complications. [1][2][3][4][5] Excessive vascular tortuosity is responsible for failed endovascular therapy in 4%-6% of cases. [1][2][3][4] Several techniques for overcoming difficult aortic arch and great vessel anatomy have been described.…”

“…[1][2][3][4][5] Excessive vascular tortuosity is responsible for failed endovascular therapy in 4%-6% of cases. [1][2][3][4] Several techniques for overcoming difficult aortic arch and great vessel anatomy have been described. Exchanging a diagnostic catheter over a stiff exchange wire is the standard maneuver, 5 but this strategy typically fails in complex Type III arches with great vessel tortuosity because of guide catheter and wire pushback and inability to access distal cervical vasculature.…”