Related Experiment Video
Updated: May 14, 2026
Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm
Published on: August 1, 2025
Endovascular repair of ascending aortic aneurysm by transapical approach and periscope technique
Hans Krankenberg1, Ralf Bader, Sebastian Sixt
1Center for Interventional Angiology, Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg, Germany. krankenberg@angiologikum-hh.de
Purpose:
To demonstrate transapical stent-graft implantation for the treatment of an ascending aortic aneurysm simultaneously using the "periscope" technique for all supra-aortic branches.
Technique:
The treatment plan is demonstrated in a 67-year-old man with prior ascending aortic replacement and known ascending aortic aneurysm who presented with acute severe chest pain. Computed tomographic angiography (CTA) revealed an 11-cm ruptured aneurysm of the ascending aorta distal to the prosthesis. Surgery was impossible due to direct contact of the aneurysm with the sternum. Conventional retrograde stent-graft implantation was infeasible because of a sharp kink of the descending thoracic aorta, so the stent-grafts were implanted via a transapical approach. To provide blood flow to the supra-aortic branches, periscope grafts oriented from the target vessels down the descending thoracic aorta were implanted in all branches before main stent-graft placement. Completion angiography and subsequent CTA documented satisfactory retrograde perfusion of the supra-aortic branches via the periscope grafts.
Conclusion:
A dual approach in terms of transapical stent-graft implantation and the periscope technique for perfusion of the supra-aortic branches may be an option for the treatment of inoperable aneurysms of the ascending aorta.
