VS08 - Maintenance Of True Lumen Wire Access With Placement Of The Terumo Thoraflex Hybrid Device

Summary: In patients with complex aortic dissection involving multiple false lumens, it is difficult to identify the true lumen from the
open surgical field. After placement of the Thoraflex Hybrid device, maintenance of wire access from the true lumen
into the device facilitates thoracic endovascular repair (TEVAR) extension distally. While the device is designed to be delivered
using a wire for true lumen placement, the monorail design of the device nosecone necessitates wire removal, and loss of
distal true lumen wire placement prior to deployment. We describe how true lumen wire access is preserved even after device
deployment, in two patients with complex aortic dissections.First, femoral artery access is obtained and wire placed in true
lumen using intravascular ultrasound and fluoroscopy. Next, a suture is threaded via a through and through horizontal
channel in the device’s nosecone. Following this, the wire is looped on itself and is secured with several silk ties. The device is
then guided into the aortic true lumen using the a"xed wire and subsequently deployed. The deployment apparatus is freed
from the graft, and the wire is pulled along with it. The silk ties are cut and the wire is kept in the graft and secured for
through and through true lumen access. Cardiac surgery then proceeds to complete the open repair and the case is concluded
by placing a TEVAR distally. Post operative imaging in our patient revealed stable changes after aortic repair and significant
true lumen expansion in both cases. Our video demonstrates a novel technique for maintenance of true lumen wire access
after deployment of the Thoraflex Hybrid device.