P288. Retrograde In-situ Fenestration Technique for a Post-coronary Arterial Bypass Grafting Patient Using a High-flow Shunting Technique
Hirosaki
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Yoshiaki Saito is a board-certified cardiovascular surgeon, holding the prestigious certification from The Japanese Board of Cardiovascular Surgery and boasting an impressive 11 years of clinical experience in the field.
Saito's commitment to advancing the field led him to the United States, where he served as a research fellow at the esteemed Gorman Cardiovascular Research Group at the University of Pennsylvania from 2016 to 2018. During this period, he distinguished himself as a leading surgeon in the lab, assuming significant responsibilities and even garnering the role of first author on a paper focusing on multimodality images of ischemic cardiomyopathy.
Upon his return to Japan, Saito continued his pursuit of excellence by successfully completing the USMLE steps 1, 2 (with ECFMG certificate), and 3, underscoring his dedication to enhancing his clinical skills and knowledge. Currently, he serves as an attending surgeon and holds the position of assistant professor/senior lecturer at Hirosaki University Graduate School of Medicine.
Saito's expertise spans a wide range of cardiovascular procedures, including OPCAB, open mitral plasty, complete aortic surgeries, and endovascular interventions such as TAVR. He has made significant contributions to the endovascular field, notably serving as the director of the stentgraft program and co-director of the TAVR program at his hospital. His proficiency in highly complex techniques, such as in-situ fenestration for endovascular total arch replacement and physician-modified endovascular fenestration/branched technique for thoracoabdominal aorta, underscores his skill and innovation in the field. His mastery extends beyond clinical practice; Saito is deeply entrenched in the academic realm, serving as a faculty member for numerous Japanese endovascular programs.
Description
Case video summary
The patient was a 70-year-old male with a history of CABG and abdominal aortic replacement. LIMA was anastomosed to the left anterior descending artery. The computed tomography showed a thoracic aortic aneurysm lying from the aortic arch to the descending thoracic aorta with a maximum diameter of 60 mm. Zone 1 left common carotid artery (LCCA) in-situ fenestration TEVAR was planned. LCCA – left subclavian arterial bypass was performed prior to the stentgraft placement. A 6Fr high-flow vascular sheath was inserted into the neck bypass graft and was connected to the 22 Fr Dryseal sheath, which was inserted from the right femoral artery for the shunting. A 40mm-20cm main Gore cTAG was deployed from Zone 1. The needle puncture for the left common carotid in-situ fenestration was difficult because of the shallow angle between LCCA and the aorta(18°). LCCA was finally reconstructed (the time from Zone 1 landing to successful puncture was 16.5 minutes), and there was no ST-segment change or circulatory instability during the puncture. There was no myocardial ischemia and stroke, and no endoleak was shown in the postoperative CT scan.
Conclusion
The left subclavian-femoral arterial shunting using a high-flow vascular sheath was a reliable technique for safely performing Zone 1 in-situ fenestration TEVAR in a patient with a history of CABG.
Authors
Yoshiaki Saito (1), Kenyu Murata (1), Yuki Imamura (1), Rin Itokawa (1), Masahito Minakawa (1)
Institutions
(1) Hirosaki University School of Medicine, Hirosaki, NA