Antegradly Performed TEVAR

We congratulate the authors for their work on the incidence of stroke in thoracic endovascular aortic replacement (TEVAR) due to arcus aorta aneursyms. We wonder if TEVAR,performed in 32 patients in whom zone 0 was intervened, was performed in the same sitting with surgical intervention to ascending aorta. We would like to know how TEVAR was performed if TEVAR was carried out in the same session. That's because if TEVAR is performed in the same session as surgical procedure it can be done antegradely from ascending aorta rather than the retrograde technique in which femoral artery is utilized. In this technique a 8-mm graft is anastomosed to ascending aorta or the graft interposed to ascending aorta. TEVAR is performed antegradely with this 8-mm graft. Performing this procedure by antegrade route provides such advantages as avoiding complications likely to develop in the iliofemoral artery used as the site of access during the procedure and ensuring sufficient length in order for the endograft deployment systems to reach the landing zones.^,  Moreover, presence of shorter carrier systems in the antegrade approach will cause delivery of less rotational power, thus providing maximum precision in the placement of the graft. Another advantage is that antegrade approach permits manual manipulations of the endograft in order to fit it to a desired position in the aortic arch, thanks to the open sternum.^,  Apart from that, there appears to be a risk of entering the false lumen in the femoral or iliac arteries upon using the retrograde route especially in dissection cases. Under the light of this knowledge we feel that it is essential to keep in mind that TEVAR can be antegradely done too, particularly in cases with thoracic aorta aneursyms where sternum is opened.