Utilizing a long sheath to minimize atheroma manipulation (minimal manipulation approach) during Zone 1 and 2 thoracic endovascular aortic repair with a shaggy aorta

J Artif Organs. 2024 Dec;27(4):424-428. doi: 10.1007/s10047-024-01440-4. Epub 2024 Mar 21.

Abstract

We have adopted a simple and reproducible approach, "minimal manipulation approach," since January 2021 in five patients to minimize the risk of thromboembolic events during Zone 1 and 2 thoracic endovascular aortic repair (TEVARs) with shaggy aorta. The approach consists of two parts: ① Use of a 65-cm-long sheath (dry seal) to deliver the endografts without touching the protruding atheroma. Covering the atheroma with the first endograft delivered at Zone 3 to the mid-descending aorta (paving the aorta), and second endograft insertion and deployment through the paved aorta with first endograft. ② Protection of the left subclavian artery using balloon catheter during TEVAR. No in-hospital mortality was recorded, and none of the patients had stroke, spinal cord ischemia, or distal embolic events.

Keywords: Long sheath; Shaggy aorta; Thoracic endovascular aortic repair.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aorta, Thoracic* / diagnostic imaging
  • Aorta, Thoracic* / surgery
  • Aortic Aneurysm, Thoracic / surgery
  • Blood Vessel Prosthesis Implantation* / instrumentation
  • Blood Vessel Prosthesis Implantation* / methods
  • Endovascular Aneurysm Repair
  • Endovascular Procedures* / methods
  • Female
  • Humans
  • Male
  • Middle Aged
  • Plaque, Atherosclerotic* / surgery