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Brachiofemoral through-and-through wire technique for hybrid arch repair
Hidetake Kawajiri, Katsuhiko Oka, Osamu Sakai, Keiichi Kanda, Hitoshi Yaku.
Kyoto Prefectural University of Medicine, Kyoto, Japan.

OBJECTIVE: Retrograde endograft insertion from iliofemoral access is a standard maneuver during thoracic endovascular aortic repair. However, retrograde endograft insertion is still quite challenging when the aortic shape is “Gothic type” or when the elephant trunk is severely collapsed. In such cases, a brachiofemoral through-and-through wire technique is used.
METHODS: Between June 2008 and October 2015, 55 patients underwent hybrid arch repair at Kyoto Prefectural University of Medicine and at four associated institutes. Of the 55 patients, the brachiofemoral through-and-through wire technique was used for 11 patients. Their mean age at procedure was 74.0 ± 7.2 years, 8 males, and 3 Kommerell diverticulum cases. Hybrid procedures were either type 1 (n = 4) or type 2 (n = 8). Gore TAG (W. L. Gore & Associates, Inc., Flagstaff, Ariz) was used in all cases.
RESULTS: Endografts were placed accurately in all patients. There were no 30-day mortality, symptomatic cerebral infarction, and paraplegia. No endoleaks were observed on postoperative CT scan. There was one in hospital death (cerebral hemorrhage), which was not associated with the procedure.
CONCLUSIONS: The brachiofemoral through-and-through wire technique is a simple and safe method when the retrograde endograft insertion is challenging. To avoid major postoperative cerebrovascular events, precise preoperative evaluation of the innominate artery is mandatory.

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