Antegrade thoracic endovascular aortic repair using an ascending aortofemoral through-and-through wire technique for a severely tortuous aorta associated with rickets.
BACKGROUND
Severe aortic tortuosity of the access route often prevents successful complete exclusion of an aneurysm in thoracic endovascular aortic repair (TEVAR).


METHODS
We performed antegrade TEVAR on a 79-year-old man with right hemiparesis. We deployed the stent graft from the ascending aorta with a tube graft conduit to treat a descending thoracic aortic aneurysm associated with rickets and multiple comorbidities. Although the application of a ministernotomy diminished the potential advantages of endovascular treatment in view of less invasive surgery, antegrade TEVAR using an ascending aortofemoral through-and-through wire technique was a good option in this patient because a conventional retrograde approach was not feasible due to his severely tortuous aorta.


CONCLUSIONS
To avoid device-related complications, it is crucial to make a prudent preoperative decision on a patient-by-patient basis, taking into account the appropriate access site, adjuvant guidewire technique, and adjunctive surgical interventions.
The Department of Cardiovascular Surgery, Numata Neurosurgery Heart-Disease Hospital, 8 Sakae-cho, Numata, 378-0014, Japan. atsumori@samba.ocn.ne.jp.
Atsushi
A
Morishita
The Department of Thoracic and Cardiovascular Surgery, Niigata University School of Medicine, Niigata, Japan.
Kazuhiko
K
Hanzawa
The Department of Surgery, Tokyo Rosai Hospital, Oota-ku, Japan.
Seiichiro
S
Katahira
The Department of Anesthesiology, Minami Machida Hospital, Machida, Japan.
Takeshi
T
Hoshino
The Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.
Hideyuki
H
Tomioka
Access route; An ascending aortofemoral through-and-through wire technique; Severe tortuous; Thoracic endovascular aortic repair