Endovascular Repair of Ascending Aortic Aneurysm by Transapical Approach and Periscope Technique

Purpose: To demonstrate transapical stent-graft implantation for the treatment of an ascending aortic aneurysm simultaneously using the periscope technique for all supra-aortic branches. Technique:The treatment plan is demonstrated in a 67-year-old man with prior ascending aortic replacement and known ascending aortic aneurysm who presented with acute severe chest pain. Computed tomographic angiography (CIA) revealed an 11-cm ruptured aneurysm of the ascending aorta distal to the prosthesis. Surgery was impossible due to direct contact of the aneurysm with the sternum. Conventional retrograde stent-graft implantation was infeasible because of a sharp kink of the descending thoracic aorta, so the stent-grafts were implanted via a transapical approach. To provide blood flow to the supra-aortic branches, periscope grafts oriented from the target vessels down the descending thoracic aorta were implanted in all branches before main stent-graft placement. Completion angiography and subsequent CIA documented satisfactory retrograde perfusion of the supra-aortic branches via the periscope grafts. Conclusion: A dual approach in terms of transapical stent-graft implantation and the periscope technique for perfusion of the supra-aortic branches may be an option for the treatment of inoperable aneurysms of the ascending aorta. J Endovasc Ther. 2013;20:13-17