Caution: Air Embolism Related to Heli-Fx EndoAnchor System in Zone 2 Thoracic Aneurysm Repair.

We report a case of significant air embolization to the ascending aorta immediately following deployment of EndoAnchors in the aortic arch during a procedure to correct a type 1A endoleak. The novel Heli-Fx EndoAnchor system (Medtronic Vascular, Santa Rosa, CA, USA) was used to deploy helical anchors in the distal aortic arch during a procedure to correct a type 1A endoleak following Zone 2 thoracic endovascular aortic repair of a saccular proximal descending thoracic aorta aneurysm (DTAA). The patient developed ST-segment elevations principally in the inferior leads and severe hypotension moments after EndoAnchor deployment at the proximal edge of the endograft. Transesophageal echocardiogram revealed severe right ventricular hypokinesis and a large amount of air in the ascending aorta. Subsequent management and clinical and radiological 30-day follow-up is presented in addition to a review of the literature and ex vivo testing with the Heli-Fx system to examine potential causes and solutions. Precautions, such as pressurized saline infusion to the side port of guiding sheath, should be used whenever manipulating catheters and sheaths such as the EndoAnchor system in the aortic arch to prevent this potentially lethal complication.