November 22, 2011 — The thoracic aorta can pose major problems for endovascular repair when there are tortuous segments. Navigating an endograft through difficult territory can prevent its precise placement, especially in the aortic arch. At this year’s VEITH Symposium, Tilo Koelbel, M.D., Ph.D., described techniques that can be used in this situation. Koelbel is associate professor of surgery and consultant vascular surgeon at the University Heart Center Hamburg, Germany. Namely he suggested using stiff wire and catheters, videoscopic help, and the transbrachiofemoral (through the arm) approach.
Koelbel then discussed a novel approach to the ascending aorta by going through the heart. There are two ways to get to the heart; one approach is through the apex of the left ventricle. The other is from the common femoral vein (in the leg) up to the atrial septum and through it with a puncture past the mitral and aortic valves.
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