Antegrade fenestration and re-entry: The legacy continues

Area of Science:

• Cardiovascular Interventions
• Vascular Surgery

Background:

• Subintimal guidewire passage during antegrade wiring is a common challenge in endovascular procedures.
• Existing techniques for antegrade re-entry include guidewire redirection, parallel wire technique, specialized re-entry devices, and retrograde approaches.

Discussion:

• Antegrade fenestration and re-entry (AFR) is a novel technique involving balloon angioplasty to create fenestrations between the false lumen and distal true lumen.
• A soft-polymer jacketed guidewire is then advanced through these fenestrations to achieve re-entry into the true lumen.
• While intuitive and cost-effective, balloon inflation in AFR may lead to subintimal hematoma, potentially impeding successful re-entry.

Key Insights:

• AFR provides a creative method for achieving antegrade re-entry.
• The technique's simplicity and low cost are advantageous.
• Potential complications like subintimal hematoma formation need careful consideration.

Outlook:

• Further research is necessary to optimize the performance of AFR.
• Understanding the technique's strengths and limitations requires additional investigation.
• Refining AFR protocols will enhance its clinical applicability in complex arterial interventions.