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Antegrade Thoracic Endovascular Aortic Repair via the Ascending Aorta
Kosuke Fujii, Toshihiko Saga, Hitoshi Kitayama.
Kinki University, Osaka, Japan.

OBJECTIVE: Adequate access is important during thoracic endovascular aortic repair (TEVAR) because of the necessity of inserting a large sheath. We performed antegrade TEVAR from the ascending aorta in six patients whose femoral arteries were too small or due to other extenuating circumstances. This approach can be useful and less invasive in certain situations. We report here the early results of our experience with antegrade TEVAR from the ascending aorta
METHODS: From December 2010 to date, we performed antegrade TEVAR from the ascending aorta on six patients. Rupture had occurred in one case and impending rupture in two. The median patient age was 79.5 years (range, 70-83). Median follow up was 4.5 months. Previous open or endovascular aortic surgery had been performed in four patients. The femoral artery diameter was inadequate in five patients. In one patient, sheath insertion through the abdominal aorta was difficult because this patient had undergone endovascular aortic repair (EVAR) for an abdominal aortic aneurysm by Endologix Powerlink® two years previously and the device had snagged the TEVAR sheath. Concomitant surgery, consisting of total arch replacement in two cases and debranching of three neck vessels in two cases, was performed in four patients. The other two patients underwent TEVAR alone.
RESULTS: Early mortality occurred in one patient due to multiple organ failure on postoperative day six, and late mortality occurred in one patient four months postoperatively due to mediastinitis. A total of two patients suffered embolic events.
CONCLUSIONS: Antegrade TEVAR can be a useful approach in patients with inadequate access. However, we experienced a high embolic event rate. Thus, this problem must be considered in future cases.

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