Thoracic Aorta Stent Grafting through Transapical Access

Saouti, Nabil; Vos, Jan Albert; Heuvel, Daniel van de; Morshuis, W. J.; Heijmen, Robin H.

doi:10.1016/j.avsg.2014.09.018

Cited by 22 publications

(15 citation statements)

References 16 publications

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“…Most important, accurate stent graft deployment has been mentioned by several groups, to be a challenge during transapical delivery. [3][4][5] This problem was handled using the unique active control deployment mechanism of the Gore cTAG stent graft. 6 In detail, stent graft expansion occurs in two steps.…”

Section: Discussionmentioning

confidence: 99%

“…Maintaining adequate brain perfusion is an important aspect of any procedure involving the aortic arch, and hypoperfusion has been suggested as a cause of periprocedural stroke in TEVAR, although direct evidence is lacking. 9 Although we have previously emphasized the importance of rapid pacing during deployment in the arch, 3 accurate positioning now proved possible without it, so even a brief episode of hypotension could be avoided. Of note, although hypoperfusion is thought to play a role in the risk of stroke, catheter and wire manipulation in the arch, leading to embolization of atherosclerotic debris, 10 are generally believed to be the principal cause of periprocedural stroke.…”

Section: Discussionmentioning

confidence: 99%

“…The next step was transapical stent graft deployment, which was performed according to previously described steps. 3 Single lung ventilation was established, and a small left anterolateral thoracotomy was made to expose the left ventricular apex.…”

Section: Placement Of An Amplatzer Vascular Plug (Avp; Abbottmentioning

confidence: 99%

“…In case the common iliac arteries are also extensively calcified and stenosed, the transapical approach is our preferred next route. This approach is associated with specific technical difficulties, because it requires antegrade stent graft delivery, 3 whereas all commercially available stent grafts have been developed for retrograde deployment. This potentially leads to problems during deployment from tip to hub, causing suboptimal proximal positioning.…”

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confidence: 99%

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A challenging double bubble thoracic aortic and proximal subclavian aneurysm treated via transapical access

Beaufort

Heuvel

Heijmen

2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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This case report describes a patient with a distal aortic arch and left subclavian artery aneurysm who was considered unsuitable for open surgical repair because of comorbidities and previous bypass surgery. Inadequate peripheral access precluded standard transfemoral thoracic endovascular aortic repair. Nonetheless, successful endovascular repair was possible via transapical access using the new Gore cTAG deployment mechanism, which allowed precise antegrade stent graft deployment in a short proximal neck. (J Vasc Surg Cases and Innovative Techniques 2020;6:80-3.)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Placement Of An Amplatzer Vascular Plug (Avp; Abbottmentioning

confidence: 99%

mentioning

confidence: 99%

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A challenging double bubble thoracic aortic and proximal subclavian aneurysm treated via transapical access

Beaufort

Heuvel

Heijmen

2020

Journal of Vascular Surgery Cases, Innovations and Techniques

Self Cite

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“…Furthermore, Saouti et al . described the efficacy of a transapical approach, which is often available in transcatheter aortic valve replacement [5]. This approach can lead to several complications such as respiratory failure by left thoracotomy, hemodynamic collapse due to aortic regurgitation, and ventricular pseudoaneurysm formation.…”

Section: Discussionmentioning

confidence: 99%

Antegrade thoracic endovascular aortic repair using an ascending aortofemoral through-and-through wire technique for a severely tortuous aorta associated with rickets

et al. 2017

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BackgroundSevere aortic tortuosity of the access route often prevents successful complete exclusion of an aneurysm in thoracic endovascular aortic repair (TEVAR).Case presentationWe performed antegrade TEVAR on a 79-year-old man with right hemiparesis. We deployed the stent graft from the ascending aorta with a tube graft conduit to treat a descending thoracic aortic aneurysm associated with rickets and multiple comorbidities. Although the application of a ministernotomy diminished the potential advantages of endovascular treatment in view of less invasive surgery, antegrade TEVAR using an ascending aortofemoral through-and-through wire technique was a good option in this patient because a conventional retrograde approach was not feasible due to his severely tortuous aorta.ConclusionsTo avoid device-related complications, it is crucial to make a prudent preoperative decision on a patient-by-patient basis, taking into account the appropriate access site, adjuvant guidewire technique, and adjunctive surgical interventions.

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