A percutaneous technique for preservation of arch branch patency during thoracic endovascular aortic repair (TEVAR): retrograde catheterization and stenting.
OBJECTIVE
To report a percutaneous endovascular technique to deal with stent-graft encroachment and coverage (partial or total) of the origin of the left common carotid artery (CCA) or the left subclavian artery during thoracic endovascular aortic repair.


METHODS
Percutaneous retrograde puncture of the left CCA was accomplished with guidewire advancement into the ascending aorta and insertion of a 6-F sheath. Balloon angioplasty and deployment of a stent across the origin of the left CCA successfully recanalized the vessel and restored normal antegrade flow and pressure. It was reasoned that the stent would maintain vessel patency by focally displacing the endograft device, preventing partial or total coverage (and obstruction) of the arch branch origin. This technique has been used successfully in 8 patients, 6 involving the left CCA and 2 the left subclavian artery. Two of the patients were lost to follow-up after 6 and 12 months. The other 6 patients have been followed from 10 to 32 months; the stented vessels have remained patent in all.


CONCLUSIONS
While the "interposition" of a bare metal stent between a thoracic endograft and the aortic wall is theoretically unappealing and potentially detrimental, as the direct interaction between the devices might undermine the integrity of one or both, we have not seen such problems in this limited clinical experience.
Criado
Frank J
FJ
Division of Vascular Surgery and Vascular Intervention, Union Memorial Hospital-MedStar Health, Baltimore, Maryland, USA. frank.criado@medstar.net
D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D000800:Angioplasty, Balloon / Q000379:methods*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D006801:Humans; D015641:Radiography, Interventional; D015607:Stents; D013348:Subclavian Artery / Q000000981:diagnostic imaging; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency