title: An externalized transseptal guidewire technique to facilitate guidewire stabilization and stent-graft passage in the aortic arch.
abstract: OBJECTIVE
  To describe a technique to facilitate passage and stable deployment of thoracic stent-grafts in patients with multiple tortuous aortic segments that may hamper endograft delivery or precise placement because of an unstable position in the aortic arch.
  
  
  METHODS
  The technique of a transseptal through-and-through guidewire is demonstrated in a patient with a ruptured thoracic aneurysm with severe tortuosity of the aorta and a right-sided, severely angulated aortic arch. The transseptal through-and-through guidewire stabilization technique allowed successful passage and deployment of a thoracic stent-graft after debranching of the right common carotid and subclavian arteries. The ruptured thoracic aneurysm was excluded, while the proximal graft edge lined up with the origin of the aberrant left innominate artery.
  
  
  CONCLUSIONS
  An externalized transseptal guidewire can facilitate endograft passage in tortuous aortic anatomies and optimize control in most severely angulated aortic arches. It may obviate the use of proximal bare stents because the proximal stent-graft is actively conformed to the inner curve of the aortic arch by the stabilizing wire. Transseptal access to the ascending aorta has the potential to become an important tool for endovascular treatment, especially for catheterization of branches and fenestrations in aortic arch stent-grafts.
authors.affiliation: Department of Vascular Medicine, University Heart Center Hamburg Eppendorf, Hamburg, Germany. tilokoelbel@googlemail.com
authors.forename: Tilo
authors.initials: T
authors.lastname: Kölbel
authors.forename: Thomas
authors.initials: T
authors.lastname: Rostock
authors.forename: Axel
authors.initials: A
authors.lastname: Larena-Avellaneda
authors.forename: Hendrik
authors.initials: H
authors.lastname: Treede
authors.forename: Olaf
authors.initials: O
authors.lastname: Franzen
authors.forename: Eike Sebastian
authors.initials: ES
authors.lastname: Debus
mesh_terms: D015901:Angiography, Digital Subtraction; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D006328:Cardiac Catheterization / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000295:instrumentation*; D004867:Equipment Design; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D015641:Radiography, Interventional; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome