Transseptal guidewire stabilization facilitates stent-graft deployment for persistent proximal ascending aortic dissection.
OBJECTIVE
To report endovascular repair of a DeBakey type I ascending aortic dissection.


METHODS
Five months after aortocoronary bypass grafting, a 56-year-old woman demonstrated a persistent ascending aortic type I dissection whose entry tear proximal to the innominate artery spiraled down the descending thoracic aorta into the iliofemoral arteries. Repair was facilitated with a guidewire passed through a transseptal sheath in the right femoral vein. The guidewire traversed the right and left atria and the left ventricle and then exited into the ascending aorta and was exteriorized through the right femoral artery. A right brachial catheter aided contrast visualization of the innominate artery. Adenosine-induced elective cardiac arrest promoted precise placement of a customized polyester-covered balloon-expandable stent, which closed the aortic rent.


CONCLUSIONS
A transseptal approach enables the guidewire to follow the curvature of the aortic arch, providing precise control of the stent-graft delivery system. This case illustrates the applicability of endovascular techniques to repair ascending aortic pathologies using readily available techniques, equipment, and drugs.
Dorros
G
G
The William Dorros-Isadore Feuer Interventional Cardiovascular Disease Foundation and St. Luke's Medical Center, Milwaukee, Wisconsin, USA. gdorros@azheart.com
Dorros
A M
AM
Planton
S
S
O'Hair
D
D
Zayed
M
M
D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D017130:Angioplasty / Q000295:instrumentation*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D015607:Stents; D014057:Tomography, X-Ray Computed