Thoracic endovascular aortic repair with true-false-true lumen deployment

Looping wire technique to facilitate true lumen wiring during TEVAR in type B aortic dissection with aneurysmal degeneration: A case report

Introduction and importance

Wiring true lumen during Thoracic Endovascular Aortic Repair (TEVAR) is sometimes difficult in complicated Type B Aortic Dissection (TBAD).

Case presentation

We treated a TBAD patient with large false lumen, compressed true lumen and multiple entries. After repeated wire misdirection to false lumen, we tried a new technique in which the wire in the false lumen was looped after entrance to true lumen and pushed distally. The looped wire was then used as guide to advance a second wire to the ascending aorta. TEVAR could then be completed with good result.

Discussion

Wiring the true lumen might be one of the most challenging steps during TEVAR in complicated TBAD. Several methods have been used to overcome the problems, but the cost and availability might be a problem in some countries. The looping wire technique may serve as an alternative method of guiding the process of wiring the true lumen during complicated TEVAR.

Conclusion

Looping wire technique can be used as an alternative method to facilitate true lumen wiring during TEVAR.

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True lumen wiring during TEVAR can be very challenging in complicated TBAD.

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IVUS is the preferred strategy for true lumen wiring, but the cost might be a problem.

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Looping wire technique can be used to facilitate true lumen wiring in complicated TBAD.

Endovascular Re-routing the Errant Aortic Endoprosthesis

The anatomic complexity of aortic dissection remains a challenge in endovascular treatment. The dissection flap may contain defects allowing accidental guidewire passage from one lumen into the other, and inadvertent device placement into the false lumen can occur. The description of this complication and its bail-out maneuvers are sparse in the literature. Herein, we describe seven patients with errant endoprosthesis re-routed with minimally invasive intervention into the true lumen.