A ‘through-and-through bowing technique’ for antegrade thoracic endovascular aneurysm repair with total arch debranching: a technical note and the initial results

Abstract The aim of this study was to evaluate the deployment accuracy of a new 'through-and-through bowing technique' that involves the deployment of the stent graft with total arch debranching via median sternotomy. The migration distance, patients' demographic characteristics, operative values and the postoperative complications were examined retrospectively. From November 2012 to February 2013, 5 patients with an aortic arch aneurysm underwent total debranching and antegrade thoracic endovascular aneurysm repair (TEVAR) (control group). Fifteen patients underwent placement using the 'through-and-through bowing technique' (bowing group) from March to November 2013. The device was deployed as follows. A stiff guide wire was passed through the debranching prosthesis via the femoral artery. By pushing the bilateral ends of the wire against the aortic arch, the device was located along the greater curvature and bent like a bow. The migration distance, defined as the distance between the pre- and post-deployment positions of the distal end of the stent graft, was measured using fluoroscopic images. There were no significant differences with respect to the patients' demographics or the operative variables between the two groups. The mean migration distance in the control group (9.4 ± 8.7 mm) was significantly longer than that in the bowing group (1.3 ± 1.5 mm). Although one major stroke occurred in the bowing group, there was no operative mortality in either group. The present paper demonstrated the precise positioning of a GORE TAG deployment using a 'through-and-through bowing technique' with total arch debranching.