Objectives:Electrosurgery has been long used in endovascular procedures, with only case reports in the aortic field. Our aim is to present a case series with the use of an electrified wire to perform catheter-based electrosurgery by applying external current through an electrocautery pen.Methods:Single-center retrospective case series of all patients undergoing complex aortic surgery from October 2020 to August 2023, in whom the electrified wire technique was used: (1) Perforation of a dissection flap or left subclavian artery (LSA) in situ endograft fenestration—a 0.014” polytetrafluoroethylene (PTFE) insulated guidewire is detached from the insulation with a scalpel at the end and a cautery pen is here attached with a clamp. A curved tip catheter or sheath is positioned against the aortic flap or the endograft (through a left brachial access in this case) and the wire pushed, crossing the flap by activating the electrocautery pen and (2) slicing a dissection flap (“powered cheese-wire technique”)—after same preparation as above, the middle section of the 0.014 guidewire is removed from the PTFE and bent into a V-shape. Once in the aorta, the guidewire crosses from the true lumen (TL) to the false lumen (FL) and a through-and-through access is obtained. Sheaths are positioned against the flap from both sides and moved up or down while the electricity is activated, slicing the flap and communicating both lumens. Technical success and technical-related complications were evaluated.Results:Eleven cases concerning aortic dissections and 1 case of aortic atresia were treated. Four patients presented urgently, whereas the rest were planned procedures. Seven cases underwent perforation of a dissection flap, 2 cases underwent the powered cheese-wire technique, in 2 cases for an LSA in situ fenestration, and in 1 case to cross an aortic atresia at the aortic isthmus. The technique was in all cases successfully applied. No complications related to the technique occurred.Conclusions:The “electrified wire” technique is a feasible and ready-available tool that can be safely used in complex aortic interventions, especially to perforate aortic tissue like dissection flaps or to perform in situ fenestrated repairs by perforation of the endograft fabric.Clinical ImpactThe electrified wire technique described herein is a straightforward technique that uses readily available tools to perform electrosurgery. We present its use in complex aortic procedures. However, it could be envisioned for any vascular procedure that requires crossing of the vessel or even prosthetic material. As we have described in this series, when used along with an adequate properative planning, it can be a safe tool of great utility, as has already been demonstarted in the field of the interventional cardiology.

中文翻译：

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复杂主动脉介入治疗中的电线技术：案例系列

目的：电外科长期以来一直用于血管内手术，仅在主动脉领域有病例报告。我们的目的是提出一个病例系列，通过电烙笔施加外部电流，使用电线进行导管电外科手术。方法：单中心回顾性病例系列，纳入 2020 年 10 月至 8 月接受复杂主动脉手术的所有患者2023年，其中使用了电线技术：（1）解剖皮瓣或左锁骨下动脉（LSA）原位内移植物开窗穿孔——用手术刀将0.014英寸聚四氟乙烯（PTFE）绝缘导丝从绝缘层上分离出来。末端和烧灼笔用夹子固定。将弯曲尖端导管或护套靠在主动脉瓣或内移植物上（在这种情况下通过左肱动脉通路）定位，并推动线，通过激活电烙笔穿过主动脉瓣，并 (2) 切割解剖瓣（“动力奶酪”） -导丝技术”）——与上述相同的准备工作后，将0.014导丝的中间部分从PTFE中取出并弯曲成V形。一旦进入主动脉，导丝就会从真腔 (TL) 穿过假腔 (FL)，并获得直通通路。护套从两侧抵住皮瓣，并在通电时向上或向下移动，切开皮瓣并连通两个管腔。评估技术成功率和技术相关并发症。结果：治疗主动脉夹层11例，主动脉闭锁1例。四名患者紧急就诊，其余患者则按计划进行手术。 7 例行夹层皮瓣穿孔，2 例行动力干酪丝技术，2 例行 LSA 原位开窗术，1 例行主动脉峡部跨主动脉闭锁。该技术在所有情况下均得到成功应用。没有发生与该技术相关的并发症。结论：“电线”技术是一种可行且现成的工具，可以安全地用于复杂的主动脉介入治疗，特别是对主动脉组织进行穿孔，如夹层皮瓣或进行原位开窗修复。临床影响本文描述的电线技术是一种简单的技术，其使用容易获得的工具来执行电外科手术。我们介绍其在复杂主动脉手术中的用途。然而，可以设想将其用于任何需要穿过血管甚至假体材料的血管手术。正如我们在本系列中所描述的，当与适当的适当规划一起使用时，它可以成为一种非常有用的安全工具，正如介入心脏病学领域已经证明的那样。