title: Transseptal ascending aortic access facilitates transcatheter embolization of proximal type I endoleak associated with bird-beak configuration of an endograft in the proximal aortic arch.
abstract: OBJECTIVE
  To report the initial use of antegrade transseptal ascending aortic access to perform transcatheter embolization of a proximal type I endoleak associated with bird-beak configuration of an endograft in the proximal aortic arch.
  
  
  METHODS
  A 61-year-old man underwent endovascular repair of a large, symptomatic aortic arch aneurysm located distal to the left common carotid artery using a fenestrated endograft. Completion angiography showed bird-beak configuration of the proximal endograft and a large type Ia endoleak. In a separate procedure, the endoleak was embolized with cyanoacrylate glue via an antegrade ascending aortic access obtained through a transseptal sheath stabilized by an indwelling arteriovenous wire loop. This approach provided straight-line access into the endoleak with requisite catheter support, and complete thrombosis of the aneurysm sac was achieved. The patient's symptoms abated, and at 1-year follow-up, there was no endoleak, and the aneurysm sac had shrunken markedly.
  
  
  CONCLUSIONS
  Antegrade transseptal ascending aortic access facilitates transcatheter embolization of type Ia endoleak in the proximal aortic arch.
authors.affiliation: 1 Department of Cardiology, Christian Medical College, Vellore, India.
authors.forename: George
authors.initials: G
authors.lastname: Joseph
authors.forename: Sujith Thomas
authors.initials: ST
authors.lastname: Chacko
authors.forename: Edwin
authors.initials: E
authors.lastname: Stephen
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Joseph
mesh_terms: D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D054087:Atrial Septum; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D006328:Cardiac Catheterization / Q000379:methods*; D004621:Embolization, Therapeutic / Q000379:methods*; D057867:Endoleak / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011677:Punctures; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: aortic arch; atrial septal puncture; fenestrated stent-graft; physician-modified device; stent-graft; thoracic aortic aneurysm; thoracic endovascular aortic repair; transcatheter embolization; transseptal sheath; type I endoleak