The catheter rendezvous technique for safe wire removal during Najuta prothesis implantation

Fenestrated aortic arch prostheses represent a robust therapeutic option for select pathologies. The Najuta is a semicustomized stent graft designed to achieve reliable sealing zones for the supra-aortic vessels through a variable number of fenestrations. A defining aspect of the procedure is the creation of a through-and-through wire (TATW), which is executed through a transaxillary approach via the fenestration of the brachiocephalic trunk. The omission of the catheter rendezvous technique for safe removal of the TATW, as described herein, may result in severe complications, including damage to the fabric or secondary dislocation of the stent graft, potentially leading to catastrophic outcomes such as aortic dissection or stroke. During implantation, the Najuta prosthesis is introduced using a 4-m soft Terumo wire configured in a transaxillary-transfemoral TATW arrangement. A loop is then formed around the aortic valve, facilitating the safe advancement of the prosthesis into the aortic arch. This loop configuration must be untied after implantation. If this is performed carelessly, excessive tension may be exerted on the medial edge of the brachiocephalic trunk fenestration, which may potentially lead to fabric damage or secondary dislocation of the entire prosthesis. To avoid this, catheters are inserted via both the transaxillary and transfemoral access points. These catheters meet at the loop area in a controlled "rendezvous" maneuver, enabling the safe removal of the TATW via the transaxillary access. The catheter rendezvous technique ensures the safe extraction of the loop TATW during the implantation of the Najuta prosthesis, thereby enhancing procedural safety and minimizing patient risk.