Department of Vascular Surgery, University Hospital and Trust of Verona, University of Verona-School of Medicine, Verona, Italy.
Department of Vascular Surgery, University Hospital and Trust of Verona, University of Verona-School of Medicine, Verona, Italy.
Ann Vasc Surg. 2022 Mar;80:393.e1-393.e5. doi: 10.1016/j.avsg.2021.09.033. Epub 2021 Nov 11.
To describe a bailout technique to advance and precisely deploy thoracic endograft in the ascending aorta in case of difficulty crossing the aortic arch.
A 73-year-old man presented with a large ruptured aneurysms in the descending aorta. During the TEVAR, stent-graft passage through the aortic arch was impossible due to the severe tortuosity of the aorta. The problem has been resolved using the sheath-anchoring rail guidewire (SARG) technique.
Through an axillary access, a snare was used to capture the stiff wire from the femoral access. A sheath was advanced over the stiff wire to the ascending aorta and placed there. By exploiting the grip of the sheath on the stiff in the ascending aorta, it was possible to handle the tension, move the delivery system through the arch and carefully deploy the graft.
The SARG is a simple and quick learning technique which can be useful for Physicians dealing with complex aortic arch anatomy.
描述一种在升主动脉中推进和精确部署胸主动脉内移植物的 bailout 技术，以防主动脉弓穿越困难。
一名 73 岁男性因降主动脉的大型破裂性动脉瘤而就诊。在 TEVAR 过程中，由于主动脉严重迂曲，支架移植物无法通过主动脉弓。使用鞘锚定轨导丝（SARG）技术解决了这个问题。
通过腋动脉入路，使用圈套器从股动脉入路捕获硬钢丝。将鞘管沿硬钢丝推进至升主动脉并放置在那里。利用鞘管在升主动脉内对硬钢丝的夹持，可以处理张力，将输送系统通过弓部并小心地展开移植物。
SARG 是一种简单快速的学习技术，对于处理复杂主动脉弓解剖结构的医生可能非常有用。
