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Tracheostomy: Procedure and Tubes01:28

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A tracheostomy is a surgical procedure that creates an artificial opening into the trachea, typically at the second or third cartilaginous ring level. This opening allows the insertion of a tracheostomy tube, which can replace an endotracheal tube, provide mechanical ventilation, bypass an upper airway obstruction, or remove accumulated tracheobronchial secretions.
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Related Experiment Video

Updated: Feb 27, 2026

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation

Published on: August 8, 2025

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Initial Experience with the Transapical Access for TEVAR.

Andreas H Mahnken1, Marc Irqsusi2, Walter Hundt1

  • 1Diagnostic & Interventional Radiology, Philipps-University Marburg, Germany.

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|July 7, 2017
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Summary
This summary is machine-generated.

Transapical access offers a feasible alternative for thoracic endovascular aortic repair (TEVAR) when transfemoral access is not possible. This approach demonstrated technical success in patients with challenging vascular anatomy, though careful planning is essential.

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Area of Science:

  • Cardiovascular Surgery
  • Interventional Radiology
  • Medical Device Technology

Background:

  • Endovascular aortic aneurysm repair is a standard treatment, with transfemoral access being the most common.
  • Vascular pathologies like occlusion, tortuosity, or calcification can render transfemoral access infeasible.
  • Transapical access presents a viable alternative route for endovascular procedures.

Observation:

  • Three patients with thoracic aortic aneurysms and inaccessible femoral arteries underwent TEVAR via transapical access.
  • The procedure involved mini-thoracotomy, left ventricular puncture, guidewire placement, and stent graft deployment under fluoroscopic guidance.
  • Technical success was achieved in all cases, with complete aneurysm exclusion and no endoleak.

Findings:

  • One patient experienced spinal ischemia leading to paraplegia and later died from esophageal rupture.
  • The remaining two patients had no procedure-related complications.
  • Transapical TEVAR is technically successful in selected patients with challenging anatomy.

Implications:

  • Transapical access is a feasible and safe alternative for TEVAR when transfemoral access is contraindicated.
  • Careful procedural planning, including consideration of stent graft orientation, is crucial.
  • Awareness of potential complications like stroke due to aortic valve vegetation is necessary.