Abstract
Branched thoracic aortic aneurysm repair requires arterial access from above the diaphragm in order to insert the visceral branches. This is routinely performed from the subclavian, axillary or carotid arteries and less commonly direct thoracic aorta puncture. The left ventricular apex is an alternative access route which is commonly used for percutaneous aortic valve replacement and rarely used for EVAR, FEVAR and TEVAR access. Here we describe two patients for which the left ventricular apex was the most suitable available access to the visceral branches during a branched thoracic aortic aneurysm repair. This access should be considered as an alternative approach if conventional arterial access is not available.
This is a preview of subscription content, log in via an institution to check access.
References
Minion DJ, Davenport DL. Access techniques for EVAR: percutaneous techniques and working with small arteries. Semin Vasc Surg. 2012;25(4):208–16.
Saadi EK, Dussin LH, Moura L, Machado AS. The axillary artery–a new approach for endovascular treatment of thoracic aortic diseases. Interact Cardiovasc Thorac Surg. 2010;11(5):617–9.
Mylotte D, Sudre A, Teiger E, Obadia JF, Lee M, Spence M, et al. Transcarotid transcatheter aortic valve replacement: feasibility and safety. JACC Cardiovasc Interv. 2016;9(5):472–80.
Botta L, Bruschi G, Fratto P, Margari V, Solcia M, Borgia F, et al. Direct transaortic TEVAR: an alternative option for selected patients with unsuitable peripheral access. Ann Thorac Surg. 2016;102(2):e117–9.
Komlo CM, Vallabhajosyula P, Bavaria JE, Desai ND, Anwaruddin S, Giri JS, et al. Combined transaortic transcatheter valve replacement and thoracic endografting. Ann Thorac Surg. 2014;97(2):696–8.
Ferrari E, Marcucci C, Sulzer C, Rizzo E, von Segesser LK. No arterial access: a ‘blind flight’ for a transapical aortic valve implantation (TAVI). J Heart Valve Dis. 2010;19(2):266–8.
MacDonald S, Cheung A, Sidhu R, Rheaume P, Grenon SM, Clement J. Endovascular aortic aneurysm repair via the left ventricular apex of a beating heart. J Vasc Surg. 2009;49(3):759–62.
Saouti N, Vos JA, van de Heuvel D, Morshuis WJ, Heijmen RH. Thoracic aorta stent grafting through transapical access. Ann Vasc Surg. 2015;29(2):362e5-9.
Ramponi F, Vallely MP, Stephen MS, Bannon PG, Bayfield MS, White GH. Transapical wire-assisted endovascular repair of thoracic aortic dissection. J Endovasc Ther. 2011;18(3):350–4.
Mahnken AH, Irqsusi M, Hundt W, Moosdorf RG. Initial experience with the transapical access for TEVAR. Rofo. 2017;189(8):760–4.
Dias-Neto M, Reis PV, Rolim D, Ramos JF, Teixeira JF, Sampaio S. Strategies to prevent TEVAR-related spinal cord ischemia. Vascular. 2017;25(3):307–15.
Ghazy TG, Ouda AS, Mashhour AM, Wilbring M, Matschke K, Kappert UW. Transapical aortic stenting: an initial case series. EuroIntervention. 2016;12(10):1305–10.
Ahn SH, Prince EA, Dubel GJ. Basic neuroangiography: review of technique and perioperative patient care. Semin Intervent Radiol. 2013;30(3):225–33.
Koifman E, Magalhaes M, Kiramijyan S, Escarcega RO, Didier R, Torguson R, et al. Impact of transfemoral versus transapical access on mortality among patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Cardiovasc Revasc Med. 2016;17(5):318–21.
Bleiziffer S, Piazza N, Mazzitelli D, Opitz A, Bauernschmitt R, Lange R. Apical-access-related complications associated with trans-catheter aortic valve implantation. Eur J Cardiothorac Surg. 2011;40(2):469–74.
Karck M, Chavan A, Hagl C, Friedrich H, Galanski M, Haverich A. The frozen elephant trunk technique: a new treatment for thoracic aortic aneurysms. J Thorac Cardiovasc Surg. 2003;125(6):1550–3.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflict of interest.
Human and Animal Rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Helmy, A., Catarino, P., Dunning, J. et al. Branched Thoraco-Abdominal Aortic Aneurysm Repair with Branch Access Through a Transapical Left Ventricular Approach. Cardiovasc Intervent Radiol 41, 1274–1279 (2018). https://doi.org/10.1007/s00270-018-1973-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-018-1973-5