Key result
Branched arch stent-grafting using a through-and-through wire technique successfully excludes emergent ascending aortic rupture.
Why the study?
A novel technique is needed to overcome rotation error during emergent endovascular repair of ruptured ascending aorta with a branched arch endograft.
Case Report (n=1)
A branch-to-branch through-and-through wire technique can successfully overcome rotation errors during emergent branched arch endograft repair of ascending aortic ruptures.
Novel rotation correction succeeds in single ruptured ascending aorta case; leaves open feasibility for wider use pending prospective validation.
Purpose: To present a novel means of overcoming a rotation error when treating a ruptured ascending aorta with a branched arch endograft. Technique: The technique is demonstrated in an 83-year-old patient with cardiac and respiratory comorbidities and a contained rupture of the ascending aorta who was referred for endovascular therapy. Computed tomography angiography (CTA) showed progressive pseudoaneurysm and mediastinal hematoma, but the limited landing zone required the use of an inner branched arch endograft that was designed for another patient. The device became malrotated clockwise during deployment, so cannulation of the first inner branch was done using a branch-to-branch through-and-through wire from the second inner branch. The final angiogram showed a good result, with patency of the supra-aortic vessels and exclusion of the rupture. The patient was discharged 2 weeks later without complications. The 1-month CTA was free from endoleak. The patient returned to his normal activity 3 months later. Conclusion: The use of a branched arch stent-graft for emergent repair of a ruptured ascending aorta is feasible.
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Eleshra et al. (2019) conducted a case report in Contained rupture of the ascending aorta (n=1). Branched arch endograft using a branch-to-branch through-and-through wire technique was evaluated on Patency of the supra-aortic vessels and exclusion of the rupture. Emergent repair of a ruptured ascending aorta using a branched arch stent-graft with a branch-to-branch through-and-through wire technique was feasible and resulted in exclusion of the rupture.
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