Purpose: We report a technique to place Gore-TAG (TAG) precisely just below the origin of the neck vessel without overstenting.
Technique: Before deploying TAG, retrograde insertion of the protection sheath through the left subclavian artery (LSCA), or the left common carotid artery (LCCA), into the aortic arch was accomplished. The proximal flare portion of TAG catheter was positioned to touch or partially cross the protection sheath. Deployment was done in the routine fashion. When the proximal portion of TAG was to protrude in the direction of the ascending aorta the protection sheath could hold the advancement of the device.
Patients: Five patients underwent thoracic endovascular aortic repair (TEVAR) using TAG with protection sheath insersion. Open direct puncture of LCCA was done in 3, while percutaneous puncture of the left brachial artery to protect LSCA was done in the remaining 2.
Result: All the patients underwent TEVAR successfully without endoleak. One patient needed additional stent placement of LCCA, which caused no proximal endoleak.
Conclusion: Protection sheath insertion into the neck vessel was useful to place TAG precisely just below its origin.
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