Use of Ascending Aortic Access for Imaging and Wire Rail Access for Endograft Delivery in Complex Aortic Arch Anatomy

Abstract In cases of complex aortic arch anatomy it may be difficult to obtain wire access into the ascending aorta for deployment of a thoracic endograft (TEVAR) from a transfemoral approach. This may be due to tortuosity or patulous aneurysmal areas making platform stability difficult. We report a case of a young-adult man with large proximal left subclavian aneurysm that made Zone 0 TEVAR placement very difficult with transfemoral access alone. Direct ascending aortic access through the open chest allowed for stable through-and-through platform for endograft delivery, highlighting the efficacy of this seldom-needed technique during debranching TEVAR procedures.