Through and Through Wire Is the Unique Way to Force Tortuous Anatomy

Abstract

A 67 year old male presented nine years after thoracic endovascular aortic repair (TEVAR) with a 98 mm thoracic aneurysm involving the ostium of the left subclavian artery, with a massive proximal type Ia endoleak. A carotid–subclavian bypass was created. Twenty-eight days later elective TEVAR (Zenith Alpha, Cook Medical, Bloomington, Indiana, USA) was carried out. Due to extreme tortuosity, the implantation required (A) a right femoral–right brachial (asterisk) through and through technique and inserting the proximal part of the delivery system (B) into the innominate artery (“Skewer technique”, arrow). The procedure was completed successfully, with no post-operative complications.Image 1