Externalized transapical guidewire technique for complex aortic disease: a single-centre experience.

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Medical Devices

Background:

• Thoracic endovascular aortic repair (TEVAR) requires specialized techniques for complex aortic anatomies.
• Traditional brachial-to-femoral guidewire configurations may be insufficient in challenging cases.
• The externalized transapical guidewire (ETAG) technique offers an alternative approach.

Purpose of the Study:

• To evaluate the utility, feasibility, and safety of the ETAG technique in patients undergoing TEVAR.
• To report clinical experience with ETAG in managing difficult aortic anatomies.
• To assess the ETAG technique's effectiveness in complex TEVAR procedures.

Main Methods:

• Retrospective review of 5 patients who underwent TEVAR using the ETAG technique (April 2015 - March 2017).
• Indications included severely angulated aorta, proximity to the aortic valve, limited landing zones, and complex atheroma.
• The ETAG technique involved navigating the delivery system along the lesser curvature of the aortic arch.

Main Results:

• Successful TEVAR completion in all 5 patients utilizing the ETAG technique.
• Enhanced conformability and tip retrieval were observed during deployment.
• No embolic complications occurred in patients with complex atheroma.
• All patients survived TEVAR; one patient died during a subsequent procedure.

Conclusions:

• The ETAG technique effectively addressed anatomical challenges during TEVAR.
• This method may reduce embolization risk by avoiding contact with the greater curvature of the aortic arch.
• ETAG is a feasible and safe alternative for complex TEVAR cases.