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Berchiolli R, Troisi N, Bertagna G, Colli A, Besola L, Silingardi R, Simonte G, Isernia G, Lenti M, Parlani G, Fino G, Covic T, Gennai S, Ferri M, Ferrero E, Quaglino S, Rizza A, Maritati G, Portoghese M, Verzini F, Discalzi A, Pulli R, Fargion A, Bonvini S, Intrieri F, Speziale F, Mansour W, Moniaci D, Troisi N, Colli A, Camparini S, Genavi G, Pratesi G, Massi F, Michelagnoli S, Chisci E, Bonardelli S, Maione M, Angiletta D, Zacà S, Veraldi GF, Mezzetto L. A technical review of bail-out procedures to place Najuta stent-graft into the ascending aorta. CVIR Endovasc 2023; 6:7. [PMID: 36809454 PMCID: PMC9944130 DOI: 10.1186/s42155-023-00351-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/23/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The Najuta stent-graft (Kawasumi Laboratories Inc., Tokyo, Japan) is usually easily advanced to the correct deployment position in the ascending aorta thanks to the pre-curved delivery J-sheath with all fenestrations automatically oriented towards the supra-aortic vessels. Aortic arch anatomy and delivery system stiffness could however represent limitations for proper endograft advancement, especially when the aortic arch bends sharply. The aim of this technical note is to report a series of bail-out procedures that could be useful to overcome the difficulties encountered during the Najuta stent-graft advancement up to the ascending aorta. MAIN BODY The insertion, positioning and deployment of a Najuta stent-graft requires a through-and-through guidewire technique using a .035″ 400 cm hydrophilic nitinol guidewire (Radifocus™ Guidewire M Non-Vascular, Terumo Corporation, Tokyo, Japan) with right brachial and both femoral accesses. When standard maneuver to put the endograft tip into the aortic arch, some bail-out procedures can be applied to obtain proper positioning. Five techniques are described into the text: positioning of a coaxial extra-stiff guidewire; positioning of a long introducer sheath down to the aortic root from the right brachial access; inflation of a balloon inside the ostia of the supra-aortic vessels; inflation of a balloon inside the aortic arch (coaxial to the device); and transapical access technique. This is a troubleshooting guide for allowing physicians to overcome various difficulties with the Najuta endograft as well as for other similar devices. SHORT CONCLUSION Technical issues in advancing the delivery system of Najuta stent-graft could occur. Therefore, the rescue procedures described in this technical note could be useful to guarantee the correct positioning and deployment of the stent-graft.
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Affiliation(s)
- Raffaella Berchiolli
- grid.5395.a0000 0004 1757 3729Vascular Surgery Unit, Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Cisanello Hospital, Via Roma 67, 56126 Pisa, Italy
| | - Nicola Troisi
- Vascular Surgery Unit, Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Cisanello Hospital, Via Roma 67, 56126, Pisa, Italy.
| | - Giulia Bertagna
- grid.5395.a0000 0004 1757 3729Vascular Surgery Unit, Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Cisanello Hospital, Via Roma 67, 56126 Pisa, Italy
| | - Andrea Colli
- grid.5395.a0000 0004 1757 3729Division of Cardiac Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Laura Besola
- grid.5395.a0000 0004 1757 3729Division of Cardiac Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Roberto Silingardi
- grid.7548.e0000000121697570Department of Vascular Surgery, University of Modena and Reggio Emilia, Nuovo Ospedale S. Agostino Estense, Modena, Italy
| | - Gioele Simonte
- grid.417287.f0000 0004 1760 3158Department of Vascular and Endovascular Surgery, University Hospital of Perugia, Perugia, Italy
| | - Giacomo Isernia
- grid.417287.f0000 0004 1760 3158Department of Vascular and Endovascular Surgery, University Hospital of Perugia, Perugia, Italy
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