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      Tratamiento endovascular del arco aórtico asegurando la salida de los troncos supraaórticos mediante fenestración in situ Translated title: Endovascular treatment of the aortic arch securing the supraaortic trunks through in-situ fenestration

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          Abstract

          Resumen El tratamiento endovascular para las lesiones del arco aórtico es cada vez más frecuente gracias al empleo de endoprótesis fenestradas. En situaciones de urgencia no siempre es posible la disponibilidad de este tipo de prótesis. Presentamos el caso de un paciente con infección reciente por COVID-19 y pseudoaneurisma del arco aórtico sintomático tratado mediante endoprótesis torácica con fenestración manual y guías precargadas.

          Translated abstract

          Abstract The use of endovascular repair for aortic arch lesions is increasing thanks to fenestrated endoprothesis. In emergency situations the availability of these endografts is not always possible. We present the case of a patient with recent COVID-19 infection and a symptomatic aortic arch pseudoaneurysm treated with a physician-made fenestrated endograft and externalized guidewires.

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          Thoracic Endovascular Aortic Repair for Challenging Aortic Arch Diseases Using Fenestrated Stent Grafts From Zone 0

          Although previous reports have described the repair of distal aortic arch aneurysms through debranching and chimney techniques, these methods invariably involve surgical management of the carotid artery. We report clinical results of thoracic endovascular aortic repair (TEVAR) using fenestrated stent grafts in the treatment of aortic arch aneurysms located less than 15 mm from the left common carotid artery.
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            Physician-Modified Thoracic Stent-Grafts for the Treatment of Aortic Arch Lesions.

            To evaluate outcomes of physician-modified thoracic stent-grafts for the treatment of aortic arch aneurysms.
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              Externalized Guidewires to Facilitate Fenestrated Endograft Deployment in the Aortic Arch

              Purpose: To describe a precannulated fenestrated endograft system utilizing externalized guidewires to facilitate aortic arch endovascular repair and to report its use in 2 patients with challenging anatomy. Technique: For distal arch repair, a fenestration for the left subclavian artery (LSA) is made onsite in a standard thoracic endograft tailored to the patient anatomy; it is precannulated with a nitinol guidewire (NGw), which is passed from the femoral artery and externalized from the left brachial artery prior to endograft delivery system introduction over a parallel stiff guidewire. Steps are then taken to remove guidewire intertwining, prevent NGw wrapping around the delivery system, and orient the LSA fenestration superiorly when the delivery system moves into the arch. Gentle traction on the ends of the NGw during endograft deployment facilitates proper fenestration alignment. A covered stent is deployed in the LSA fenestration. The technique is illustrated in a patient with congenital coarctation of the aorta and descending aortic aneurysm. For total arch repair, endograft fenestrations are made for all 3 arch branches; the left common carotid artery (LCCA) and LSA fenestrations are each cannulated with NGws, which travel together from the femoral artery, pass through a LSA snare loop, and are exteriorized from the LCCA. After endograft deployment, the innominate artery fenestration is separately cannulated using right brachial access. Placement of a parallel externalized hydrophilic guidewire passing through the LCCA fenestration (but not the LSA snare loop) and removal of the LCCA fenestration NGw allows exteriorization of the LSA fenestration NGw from the left brachial artery by pulling the LSA snare. Covered stents are deployed in all 3 fenestrations. The technique is presented in a patient with type B aortic dissection. Conclusion: Use of the precannulated fenestrated endograft system described is feasible and has the potential to make aortic arch endovascular repair simpler, more reliable, and safer.
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                Author and article information

                Journal
                angiologia
                Angiología
                Angiología
                Arán Ediciones S.L. (Madrid, Madrid, Spain )
                0003-3170
                1695-2987
                August 2021
                : 73
                : 4
                : 199-201
                Affiliations
                [1] Madrid orgnameHospital Universitario Fundación Jiménez Díaz orgdiv1Cirugía Vascular y Endovascular orgdiv2Servicio de Angiologí Spain
                Article
                S0003-31702021000400006 S0003-3170(21)07300400006
                10.20960/angiologia.00283
                b37b65dc-11f3-4aa2-a991-9c2de3915196

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 13 February 2021
                : 23 February 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 4, Pages: 3
                Product

                SciELO Spain

                Categories
                Casos Clínicos

                Aortic arch,Fenestrated endoprosthesis,Fenestration,Pseudoaneurysm,Arco aórtico,Endoprótesis fenestrada,Fenestración,Pseudoaneurisma

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