A Case Report of Endografting Using a Long Sheath under the Assistance of a Through-and-Thorough Wire Technique for an Extremely Tortuous Aortic Anatomy

Introduction: Despite its rapid technological development and widespread uptake for thoracic aortic disease, an extremely tortuous aortic anatomy is considered a contraindication for thoracic endovascular aortic repair procedure. We report a case of a successful thoracic endovascular aortic repair using techniques to straighten an extremely tortuous aorta friendly. Methods: A 78-year-old man with frequent surgical history of aortic repair was admitted to our outpatient clinic because of dyspnea and back pain. Enhanced computed tomography scan revealed type Ib endoleak, acute enlargement of the remnant native aorta and an extremely tortuous aorta. We successfully performed a thoracic endovascular aortic repair using a Gore DrySeal 65 cm sheath, combined with a Gore C-Tag device under the assistance of a through-and-thorough wire technique in the distal descending aorta. Conclusions: Using all the available techniques, thoracic endovascular aortic repair can be performed even in the most challenging cases.