title: [Preservation of arch branch patency during the placement of Gore-TAG; protection sheath insertion method].
abstract: OBJECTIVE
  We report a technique to place Gore-TAG (TAG) precisely just below the origin of the neck vessel without overstenting.
  
  
  METHODS
  Before deploying TAG, retrograde insertion of the protection sheath through the left subclavian artery (LSCA), or the left common carotid artery (LCCA), into the aortic arch was accomplished. The proximal flare portion of TAG catheter was positioned to touch or partially cross the protection sheath. Deployment was done in the routine fashion. When the proximal portion of TAG was to protrude in the direction of the ascending aorta the protection sheath could hold the advancement of the device.
  
  
  METHODS
  Five patients underwent thoracic endovascular aortic repair (TEVAR) using TAG with protection sheath insersion. Open direct puncture of LCCA was done in 3, while percutaneous puncture of the left brachial artery to protect LSCA was done in the remaining 2.
  
  
  RESULTS
  All the patients underwent TEVAR successfully without endoleak. One patient needed additional stent placement of LCCA, which caused no proximal endoleak.
  
  
  CONCLUSIONS
  Protection sheath insertion into the neck vessel was useful to place TAG precisely just below its origin.
authors.affiliation: Department of Cardiovascular Surgery, NTT Higashi Nihon Sapporo Hospital, Sapporo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Matsuzaki
authors.forename: Ko
authors.initials: K
authors.lastname: Takigami
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsuura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery* / Q000628:therapy; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D015607:Stents; D058017:Vascular Grafting / Q000379:methods*; D014654:Vascular Patency