Right Anterior Oblique-Based Approach for Managing Wire Wrap During Fenestrated TEVAR

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Medical Device Technology

Background:

• Fenestrated thoracic endovascular aortic repair (f-TEVAR) is complex, especially in the aortic arch.
• Intraoperative challenges like "wire wrap" can complicate graft deployment and increase risks.
• Standardized techniques are needed to improve predictability and safety in f-TEVAR.

Purpose of the Study:

• To describe a standardized technique for managing "wire wrap" during f-TEVAR.
• To enhance wire position predictability and reduce device manipulations.
• To improve procedural safety in aortic arch endovascular repair.

Main Methods:

• Detailed preoperative imaging for graft selection and positioning.
• Utilization of a through-and-through wire system.
• Identification of three wire positions and specific rotational maneuvers to correct "wire wrap" in the descending thoracic aorta.
• Ensuring precise fenestration alignment with supra-aortic branches before deployment.

Main Results:

• The technique successfully managed "wire wrap" in three representative cases, including complex grafts.
• It facilitated precise alignment of fenestrations with target vessels.
• The approach minimized device manipulation and optimized procedural efficiency.

Conclusions:

• The systematic approach to "wire wrap" management in f-TEVAR minimizes risks of embolization and device distortion.
• This reproducible technique enhances procedural safety and efficiency in challenging aortic arch pathologies.
• It offers a simple, adoptable strategy for safer dissemination of complex endovascular techniques.