Management of arterial access for thoracic endovascular aortic repair

Problems associated with arterial access can sometimes occur in elder patients with arteriosclerosis. This study examined the management of patients with restricted arterial access using thoracic endovascular aortic repair (TEVAR). Thirty-four consecutive patients underwent TEVAR at our institution. TEVAR was performed using a Gore TAG device (n = 20), Talent thoracic stent graft (n = 10), and a homemade endoprosthesis device (n = 3). The sizes of the applied sheath introducer or delivery catheter were 20 Fr (n = 1), 22 Fr (n = 12), 24 Fr (n = 17), and 25 Fr (n = 4). Although the procedure was completed in all cases, additional procedures for catheter preparation were required in 8 patients (23.5%). Percutaneous transluminal angioplasty (PTA) with stents placed in the iliac artery (n = 3) or the installation of a bypass conduit (n = 4) was also carried out. For the remaining cases, in which advancement of the TAG sheath introducer to the appropriate position was not possible, the endoprosthesis was deployed without the sheath introducer. Two cases required PTA after the procedure due to an injury of the iliac artery. Although some additional procedures may be required, TEVAR can be performed in patients with problems of arterial access.