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Use of the right brachio-femoral wire approach to manage a thoracic aortic aneurysm in an extremely angulated and tortuous aorta with an endoluminal stent graft

^a Division of Cardiac Surgery, North Western Memorial Hospital, 201 East Huron Street, Galter 11-140, Chicago, IL 60611, USA
^b Department of Cardiovascular and Endovascular Surgery, Arizona Heart Hospital and Arizona Heart Institute, Phoenix, AZ, USA

*Corresponding author. Tel.: +1-312-695-3121; fax: +1-312-695-1903.

E-mail address: jkpodonu{at}yahoo.com (J. Kpodonu).

The presence of a tortuous, elongated thoracic aorta and an angulated arch poses a technical challenge for the delivery of an endoluminal graft to the target site to exclude management of a thoracic aortic aneurysm. Despite the availability of a flexible delivery sheath system, adjunct techniques are necessary to deal with extremely tortuous thoracic aortas. The use of a brachio-femoral wire with tension applied at both ends is a useful technique to deliver an endoluminal graft in an angulated thoracic arch. We describe the use of a right brachio-femoral wire approach to treat a thoracic aortic aneurysm in a 75-year-old man with an elongated, tortuous and angulated arch aorta.

Key Words: Thoracic aneurysm; Endoluminal graft; Brachio-femoral wire