title: The Ascending Aorta as an Exit Site for a Through-and-Through Wire in TEVAR.
abstract: OBJECTIVE
  To describe a technique for trans-ascending aorta through-and-through guidewire placement for thoracic endograft advancement and deployment.
  
  
  METHODS
  A 55-year-old man presented with a symptomatic pseudoaneurysm of the distal aortic arch after aortic coarctation open repair. He had also undergone mechanical aortic valve replacement. Planned were a left-sided carotid-subclavian bypass and a thoracic endovascular aortic repair with a chimney graft to the left common carotid artery. After carotid-subclavian bypass, efforts to retrograde cannulate the aortic arch and advance the thoracic endograft were unsuccessful. Because of the mechanical heart valve, no transapical approach could be used. Access to the ascending aorta was gained through a midline sternotomy. A through-and-through wire was positioned from the ascending aorta to femoral artery, which provided the required stability for advancement of the thoracic endograft. Six-month computed tomography documented patent endografts and carotid-subclavian bypass and no evidence of endoleak.
  
  
  CONCLUSIONS
  A trans-ascending aorta through-and-through guidewire is a feasible adjunct that can be added to the endovascular armamentarium when transcardiac or transbrachial approaches are impossible or ineffective.
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Cologne, Germany silke.brunkwall@uk-koeln.de.
authors.forename: Silke
authors.initials: S
authors.lastname: Brunkwall
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Cologne, Germany.
authors.forename: Wael
authors.initials: W
authors.lastname: Ahmad
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Cologne, Germany.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Mylonas
authors.affiliation: Department of Surgery, Kasr El Aini Hospital, Faculty of Medicine, Cairo, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Sharkawy
authors.affiliation: Department of Cardiovascular Surgery, University of Cologne, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Wippermann
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Cologne, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Brunkwall
mesh_terms: D017541:Aneurysm, False / Q000601:surgery*; D001011:Aorta / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: aortic arch aneurysm; aortic coarctation pseudoaneurysm; stent-graft; thoracic aorta; thoracic endovascular aortic repair; through-and-through guidewire; vascular access