Externalized Transapical Guidewire for Aortic Arch Aneurysm Repair.

A 77-year-old woman with previous coronary artery bypass grafting and total arch replacement with the elephant-trunk technique was now planned for thoracic endovascular repair of residual distal aortic arch aneurysm. Because of her unfavorable aortic anatomy (severely angulated arch, previous graft, and short distance from aortic valve to proximal landing zone), we elected to use an externalized transapical guidewire technique with a through-and-through wire. By placing tension on the wire to transmit torque and force, we could advance the endograft tip safely through the angulated aorta and deploy the endograft sections accurately along the greater curvature of the aortic arch.