A technical review of bail-out procedures to place Najuta stent-graft into the ascending aorta.
Aortic arch
Najuta stent-graft
Thoracic endovascular aortic repair (TEVAR)
Journal
CVIR endovascular
ISSN: 2520-8934
Titre abrégé: CVIR Endovasc
Pays: Switzerland
ID NLM: 101738484
Informations de publication
Date de publication:
21 Feb 2023
21 Feb 2023
Historique:
received:
16
12
2022
accepted:
23
01
2023
entrez:
22
2
2023
pubmed:
23
2
2023
medline:
23
2
2023
Statut:
epublish
Résumé
The Najuta stent-graft (Kawasumi Laboratories Inc., Tokyo, Japan) is usually easily advanced to the correct deployment position in the ascending aorta thanks to the pre-curved delivery J-sheath with all fenestrations automatically oriented towards the supra-aortic vessels. Aortic arch anatomy and delivery system stiffness could however represent limitations for proper endograft advancement, especially when the aortic arch bends sharply. The aim of this technical note is to report a series of bail-out procedures that could be useful to overcome the difficulties encountered during the Najuta stent-graft advancement up to the ascending aorta. The insertion, positioning and deployment of a Najuta stent-graft requires a through-and-through guidewire technique using a .035″ 400 cm hydrophilic nitinol guidewire (Radifocus™ Guidewire M Non-Vascular, Terumo Corporation, Tokyo, Japan) with right brachial and both femoral accesses. When standard maneuver to put the endograft tip into the aortic arch, some bail-out procedures can be applied to obtain proper positioning. Five techniques are described into the text: positioning of a coaxial extra-stiff guidewire; positioning of a long introducer sheath down to the aortic root from the right brachial access; inflation of a balloon inside the ostia of the supra-aortic vessels; inflation of a balloon inside the aortic arch (coaxial to the device); and transapical access technique. This is a troubleshooting guide for allowing physicians to overcome various difficulties with the Najuta endograft as well as for other similar devices. Technical issues in advancing the delivery system of Najuta stent-graft could occur. Therefore, the rescue procedures described in this technical note could be useful to guarantee the correct positioning and deployment of the stent-graft.
Sections du résumé
BACKGROUND
BACKGROUND
The Najuta stent-graft (Kawasumi Laboratories Inc., Tokyo, Japan) is usually easily advanced to the correct deployment position in the ascending aorta thanks to the pre-curved delivery J-sheath with all fenestrations automatically oriented towards the supra-aortic vessels. Aortic arch anatomy and delivery system stiffness could however represent limitations for proper endograft advancement, especially when the aortic arch bends sharply. The aim of this technical note is to report a series of bail-out procedures that could be useful to overcome the difficulties encountered during the Najuta stent-graft advancement up to the ascending aorta.
MAIN BODY
METHODS
The insertion, positioning and deployment of a Najuta stent-graft requires a through-and-through guidewire technique using a .035″ 400 cm hydrophilic nitinol guidewire (Radifocus™ Guidewire M Non-Vascular, Terumo Corporation, Tokyo, Japan) with right brachial and both femoral accesses. When standard maneuver to put the endograft tip into the aortic arch, some bail-out procedures can be applied to obtain proper positioning. Five techniques are described into the text: positioning of a coaxial extra-stiff guidewire; positioning of a long introducer sheath down to the aortic root from the right brachial access; inflation of a balloon inside the ostia of the supra-aortic vessels; inflation of a balloon inside the aortic arch (coaxial to the device); and transapical access technique. This is a troubleshooting guide for allowing physicians to overcome various difficulties with the Najuta endograft as well as for other similar devices.
SHORT CONCLUSION
CONCLUSIONS
Technical issues in advancing the delivery system of Najuta stent-graft could occur. Therefore, the rescue procedures described in this technical note could be useful to guarantee the correct positioning and deployment of the stent-graft.
Identifiants
pubmed: 36809454
doi: 10.1186/s42155-023-00351-4
pii: 10.1186/s42155-023-00351-4
pmc: PMC9944130
doi:
Types de publication
Journal Article
Langues
eng
Pagination
7Investigateurs
Matteo Orrico
(M)
Massimo Lenti
(M)
Gianbattista Parlani
(G)
Gianluigi Fino
(G)
Tea Covic
(T)
Stefano Gennai
(S)
Michelangelo Ferri
(M)
Emanuele Ferrero
(E)
Simone Quaglino
(S)
Antonio Rizza
(A)
Gabriele Maritati
(G)
Michele Portoghese
(M)
Fabio Verzini
(F)
Andrea Discalzi
(A)
Raffaele Pulli
(R)
Aaron Fargion
(A)
Stefano Bonvini
(S)
Francesco Intrieri
(F)
Francesco Speziale
(F)
Wassim Mansour
(W)
Diego Moniaci
(D)
Nicola Troisi
(N)
Andrea Colli
(A)
Stefano Camparini
(S)
Genadiev Genavi
(G)
Giovanni Pratesi
(G)
Francesco Massi
(F)
Stefano Michelagnoli
(S)
Emiliano Chisci
(E)
Stefano Bonardelli
(S)
Massimo Maione
(M)
Domenico Angiletta
(D)
Sergio Zacà
(S)
Gian Franco Veraldi
(GF)
Luca Mezzetto
(L)
Informations de copyright
© 2023. The Author(s).
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