Purpose: To report the initial use of antegrade transseptal ascending aortic access to perform transcatheter embolization of a proximal type I endoleak associated with bird-beak configuration of an endograft in the proximal aortic arch.
Case report: A 61-year-old man underwent endovascular repair of a large, symptomatic aortic arch aneurysm located distal to the left common carotid artery using a fenestrated endograft. Completion angiography showed bird-beak configuration of the proximal endograft and a large type Ia endoleak. In a separate procedure, the endoleak was embolized with cyanoacrylate glue via an antegrade ascending aortic access obtained through a transseptal sheath stabilized by an indwelling arteriovenous wire loop. This approach provided straight-line access into the endoleak with requisite catheter support, and complete thrombosis of the aneurysm sac was achieved. The patient's symptoms abated, and at 1-year follow-up, there was no endoleak, and the aneurysm sac had shrunken markedly.
Conclusion: Antegrade transseptal ascending aortic access facilitates transcatheter embolization of type Ia endoleak in the proximal aortic arch.
Keywords: aortic arch; atrial septal puncture; fenestrated stent-graft; physician-modified device; stent-graft; thoracic aortic aneurysm; thoracic endovascular aortic repair; transcatheter embolization; transseptal sheath; type I endoleak.