“squid-凯发官网入口

case report‘‘squid-capture’’ modif i ed in situ stent–graft fenestrationtechnique for aortic arch aneurysm repairnorio hongo • shinji miyamoto • rieko shuto • tomoyuki wada •noritaka kamei • aiko sato • shunro matsumoto • hiro kiyosue •hiromu morireceived: 22 march 2014/accepted: 7 may 2014/published online: 19 june 2014? springer science business media new york and the cardiovascular and interventional radiological society of europe (cirse) 2014abstract an 83-year-old female was found to have anfusiform aneurysm in the aortic arch. she was deemed tobe a high surgical risk; therefore, endovascular stent–graftplacement followed by revascularization of the brachi-ocephalic trunk using in situ stent–graft fenestration wasconsidered. however, the safe application of fenestrationwas deemed diff i cult due to the tortuosity of the brachi-ocephalic artery. the patient was successfully treated withthe aid of the ‘‘squid-capture’’ technique, which consists ofdeployment of the stent–graft in a snare wire loop that wasadvanced from the brachiocephalic artery and fenestrationof the stent–graft with the support of the loop. a follow-upexam revealed complete sealing of the aneurysm withoutany complications. the squid-capture technique allows forthe safe and secure puncture of the graft.keywords arterial intervention ? aorta ?endovascular aneurysm repair/endovascular aorticrepair?thoracicaorticaneurysm?insitufenestration?total aortic arch reconstructionintroductionthe major limiting factor of thoracic endovascular aorticrepair (tevar) for the treatment of thoracic aortic aneu-rysms (taa) involving the aortic arch is an inappropriatelanding zone, such as a short, irregular, or angled neck, thatdoes not ensure an adequate seal. although supra-aorticarteries may be covered to gain a proximal landing zone,this step often necessitates additional extra-anatomicalbypass surgery to maintain blood f l ow to the carotid orsubclavian arteries [1, 2]. covering the brachiocephalicartery necessitates prior total debranching of the supra-aortic trunks through a sternotomy [2], which renders thesehybrid procedures highly invasive.retrograde in situ fenestration is an endovascular optionfor revascularization of the supra-aortic branches aftercovering the supra-aortic arteries. in this technique, thestent–graft is f i rst deployed in the aorta prior to beingpunctured and then fenestrated in situ by a retrogradeapproach from the target vessel. this technique also can beadapted to revascularize the brachiocephalic artery after azone 0 landing, which allows endovascular aortic archreconstruction without performing a sternotomy or aorticn. hongo (&) ? r. shuto ? n. kamei ? s. matsumoto ?h. kiyosue ? h. moridepartment of radiology, oita university faculty of medicine,idaigaoka hasama-machi, yufu-shi, oita 879-5593, japane-mail: hongou@oita-u.ac.jpr. shutoe-mail: shutor@oita-u.ac.jpn. kameie-mail: nkamein@oita-u.ac.jps. matsumotoe-mail: matsushu@oita-u.ac.jph. kiyosuee-mail: hkiyosue@oita-u.ac.jph. morie-mail: morihrmu@oita-u.ac.jps. miyamoto ? t. wada ? a. satodepartment of cardiovascular surgery, oita universityfaculty of medicine, idaigaoka hasama-machi, yufu-shi,oita 879-5593, japane-mail: smiyamot@oita-u.ac.jpt. wadae-mail: wada@oita-u.ac.jpa. satoe-mail: aikosato@oita-u.ac.jp123cardiovasc intervent radiol (2014) 37:1093–1098doi 10.1007/s00270-014-0933-y