Looping wire technique to facilitate true lumen wiring during TEVAR in type B aortic dissection with aneurysmal degeneration

Figures

• 

  Fig. 1. Aortic CT of the patient. A. Coronal view of the aortic CT, showing large false lumen and primary entry tear located 1.5 cm distal to Left Subclavian Artery. B. Axial CT view showing very large false lumen and very small true lumen. C, D. Visceral organs are supplied by either true lumen or combination of true and false lumen. E. The dissection involves the left but not the right iliac artery.

• 

  Fig. 2. Looping wire technique TEVAR. A. Initial aortogram showing Type B Aortic dissection with large entry tear and large false lumen. The position of the pigtail at the descending aorta is clearly in the false lumen and went to the true lumen through the entry tear distal to the left subclavian artery. During the aortogram, the pigtail was pushed to the false lumen. B. Terumo exchange wire was looped from descending aortic false lumen to the descending aortic true lumen through the entry tear. C. The tip of the exchange wire cross path with the proximal part of the wire at the abdominal aorta, presumably at the level of exit tear near the SMA. Another wire was then advance with MP catheter following the track of the looped wire. D. Wire configuration after the second wire can be successfully advanced into the ascending aorta through the true lumen. E. Aortogram after the second wire can be advanced to the ascending aorta through the true lumen. Aortogram clearly showed the position of the looped wire and the catheter in the true lumen (arrows), while the proximal part of the wire was in the false lumen (arrowheads). F. Final aortogram after stent graft implantation showing complete…

• 

  Fig. 3. 3 month follow-up CT and proximal extension graft. A. Follow-up CT showing type 1A endoleak. B. Initial aortogram also showing type 1A endoleak. C. Final aortogram showing complete exclusion of the endoleak.