Complete Antegrade Transapical Deployment of a Branched Aortic Arch Endograft: A Porcine Feasibility Study

Endovascular Options for the Ascending Aorta and Aortic Arch: A Scoping Review

The gold standard for aneurysmal repair of the ascending aorta and the aortic arch has been open surgery with an established track record of good results in suitable patients. In recent years, with innovations in the endovascular field alternative endovascular solutions for pathologies of the aortic arch and ascending aorta became available. At first reserved only for highly selected patients unfit for open surgery, endovascular aortic arch repair is now being offered to patients with suitable anatomy in high-volume referral centers after discussion in an interdisciplinary team. The present scoping review aims at providing an overview on indications, available devices, technical aspects, and feasibility studies of endovascular arch repair both in elective and emergent situations, including also experiences and considerations from our center.

Antegrade transapical branch deployment for endovascular aortic-arch repair by in situ fenestration

A 76-year-old man presented with an aortic arch aneurysm and was considered a candidate for endovascular aortic arch repair by in situ fenestration. Alternative access routes were explored because of atherosclerotic disease of the descending aorta and bilateral carotid arteries. Transapical deployment of both an aortic and a branched stent grafts was successfully conducted without cerebral complications. The transapical access might have the potential to reduce the risks of complications related to large bore-sheath insertion to the carotid arteries.

Transapical Access for Antegrade Catheterization of the Inner Branches of an Arch Stent-Graft Deployed Distal to an Ascending Arch Stent-Graft

Propose: To describe a technique for antegrade cannulation and bridging of the supra-aortic branches through a transapical access in the treatment of an arch aneurysm using combined ascending and branched arch stent-grafts. Technique: An 81-year-old man with a past history of open infrarenal aortic repair, emergent endovascular aortic repair for thoracic aortic rupture, and later perivisceral 4-vessel branched endovascular repair of type I thoracoabdominal aneurysm presented for repair of a concomitant 7.5-cm arch aneurysm. Because of a 44-mm ascending aorta, a tapered 50/44-mm ascending stent-graft was delivered through a transapical access to establish an adequate landing zone before implantation of a 46-mm inner branched arch device via a transfemoral route. Innominate and left subclavian arteries were antegradely cannulated and bridged through the existing transapical path. Conclusion: Our case demonstrates the feasibility of transapical access for cannulation of an arch branched device, while introducing the theoretical possibility of completing the entire procedure through a transapical access.