Systematic cervical approach for endovascular treatment of thoracic aortic diseases with debranching

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Medical Device Technology

Background:

• Thoracic endovascular aortic repair (TEVAR) often necessitates supra-aortic arterial trunk debranching.
• Achieving an adequate proximal landing zone is crucial for successful TEVAR, especially in landing zones 1 to 3.
• Existing methods for debranching can be complex and time-consuming.

Purpose of the Study:

• To introduce and evaluate a systematic 4-step strategy for facilitating TEVAR procedures.
• To simplify the process of creating an acceptable proximal landing zone for TEVAR.
• To improve the efficiency and safety of TEVAR in cases requiring supra-aortic trunk management.

Main Methods:

• A 4-step strategy involving primary surgical cervical exposure of supra-aortic trunks.
• Insertion of a 5 Fr introducer via cervical access to delineate the landing zone.
• Deployment of the thoracic endograft through femoral access.
• Immediate completion of surgical debranching (transposition or bypass).

Main Results:

• The proposed strategy systematically addresses the need for supra-aortic trunk debranching.
• This approach facilitates precise landing zone delineation for TEVAR.
• It allows for efficient endograft deployment and subsequent surgical debranching.

Conclusions:

• The described 4-step strategy offers a systematic and effective method for TEVAR.
• This technique simplifies supra-aortic trunk management, enhancing proximal landing zone creation.
• It holds potential for improving outcomes in complex TEVAR cases involving landing zones 1 to 3.