Department of Vascular Medicine, University Heart Center Hamburg Eppendorf, Hamburg, Germany.
J Endovasc Ther. 2010 Dec;17(6):744-9. doi: 10.1583/10-3189.1.
To describe a technique to facilitate passage and stable deployment of thoracic stent-grafts in patients with multiple tortuous aortic segments that may hamper endograft delivery or precise placement because of an unstable position in the aortic arch.
The technique of a transseptal through-and-through guidewire is demonstrated in a patient with a ruptured thoracic aneurysm with severe tortuosity of the aorta and a right-sided, severely angulated aortic arch. The transseptal through-and-through guidewire stabilization technique allowed successful passage and deployment of a thoracic stent-graft after debranching of the right common carotid and subclavian arteries. The ruptured thoracic aneurysm was excluded, while the proximal graft edge lined up with the origin of the aberrant left innominate artery.
An externalized transseptal guidewire can facilitate endograft passage in tortuous aortic anatomies and optimize control in most severely angulated aortic arches. It may obviate the use of proximal bare stents because the proximal stent-graft is actively conformed to the inner curve of the aortic arch by the stabilizing wire. Transseptal access to the ascending aorta has the potential to become an important tool for endovascular treatment, especially for catheterization of branches and fenestrations in aortic arch stent-grafts.
描述一种技术，以促进在多个迂曲主动脉段的患者中胸主动脉内支架移植物的通过和稳定部署，这些主动脉段可能由于主动脉弓中的不稳定位置而妨碍移植物的输送或精确放置。
在一名患有胸主动脉瘤破裂、主动脉严重迂曲和右侧严重成角主动脉弓的患者中演示了经房间隔贯穿导丝技术。经房间隔贯穿导丝稳定技术允许在右颈总动脉和锁骨下动脉分支后成功通过和部署胸主动脉内支架移植物。破裂的胸主动脉瘤被排除，而近端移植物边缘与异常左无名动脉的起源对齐。
外部化经房间隔导丝可促进迂曲主动脉解剖结构中的移植物通过，并在最严重成角的主动脉弓中优化控制。它可能避免使用近端裸支架，因为稳定导丝使近端支架移植物主动顺应主动脉弓的内曲线。经房间隔进入升主动脉有可能成为血管内治疗的重要工具，特别是用于主动脉弓支架移植物分支和开窗的导管插入术。
