title: Endovascular repair of ascending aortic aneurysm by transapical approach and periscope technique.
abstract: OBJECTIVE
  To demonstrate transapical stent-graft implantation for the treatment of an ascending aortic aneurysm simultaneously using the "periscope" technique for all supra-aortic branches.
  
  
  METHODS
  The treatment plan is demonstrated in a 67-year-old man with prior ascending aortic replacement and known ascending aortic aneurysm who presented with acute severe chest pain. Computed tomographic angiography (CTA) revealed an 11-cm ruptured aneurysm of the ascending aorta distal to the prosthesis. Surgery was impossible due to direct contact of the aneurysm with the sternum. Conventional retrograde stent-graft implantation was infeasible because of a sharp kink of the descending thoracic aorta, so the stent-grafts were implanted via a transapical approach. To provide blood flow to the supra-aortic branches, periscope grafts oriented from the target vessels down the descending thoracic aorta were implanted in all branches before main stent-graft placement. Completion angiography and subsequent CTA documented satisfactory retrograde perfusion of the supra-aortic branches via the periscope grafts.
  
  
  CONCLUSIONS
  A dual approach in terms of transapical stent-graft implantation and the periscope technique for perfusion of the supra-aortic branches may be an option for the treatment of inoperable aneurysms of the ascending aorta.
authors: Center for Interventional Angiology, Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg, Germany. krankenberg@angiologikum-hh.de
authors: Hans
authors: H
authors: Krankenberg
authors: Ralf
authors: R
authors: Bader
authors: Sebastian
authors: S
authors: Sixt
authors: Thilo
authors: T
authors: Tübler
authors: Carsten
authors: C
authors: Schwencke
authors: Dietmar
authors: D
authors: Kivelitz
authors: Ashrat
authors: A
authors: Rad
authors: Michael
authors: M
authors: Caspary
authors: Thomas
authors: T
authors: Zeller
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D008297:Male; D015607:Stents