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

Hidetake Kawajiri; Takuma Kobayashi; Kaichiro Manabe; Keiichi Kanda; Satoshi Numata

doi:10.1007/s10047-024-01440-4

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 Mar 21. doi: 10.1007/s10047-024-01440-4. Online ahead of print.

Authors

Hidetake Kawajiri¹, Takuma Kobayashi², Kaichiro Manabe², Keiichi Kanda², Satoshi Numata²

Affiliations

¹ Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan. kawajiri@koto.kpu-m.ac.jp.
² Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.

PMID: 38512476
DOI: 10.1007/s10047-024-01440-4

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.