Externalized Transapical Guidewire for Aortic Arch Aneurysm Repair

Area of Science:

• Cardiovascular Surgery
• Vascular Endovascular Therapy
• Aortic Aneurysm Repair

Background:

• Thoracic endovascular aortic repair (TEVAR) is a minimally invasive option for aortic aneurysms.
• Complex aortic anatomy, including severe angulation and previous grafts, poses challenges for TEVAR.
• Standard guidewire techniques may be insufficient in highly tortuous or anatomically challenging aortas.

Observation:

• A 77-year-old woman with a history of coronary artery bypass grafting and total arch replacement required TEVAR for a distal aortic arch aneurysm.
• Her anatomy presented significant challenges: a severely angulated arch, prior graft, and limited proximal landing zone.
• An externalized transapical guidewire technique using a through-and-through wire was employed.

Findings:

• The externalized transapical guidewire technique allowed for controlled advancement of the endograft.
• Tension on the guidewire facilitated torque transmission, enabling navigation through the angulated aortic arch.
• Accurate deployment of the endograft along the greater curvature of the aortic arch was achieved.

Implications:

• This technique offers a viable solution for TEVAR in patients with unfavorable aortic anatomy.
• It potentially expands the applicability of minimally invasive aortic repair in complex cases.
• Further research may validate this approach for similar challenging aortic pathologies.