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Removal of Arterial Lines and Devices From the Ascending Aorta in Cardiac Surgery Patients

Brinster, Derek R. MD*; Chinichian, Shideh

Innovations:Technology and Techniques in Cardiothoracic and Vascular Surgery: January/February 2014 - Volume 9 - Issue 1 - p 72–73
doi: 10.1097/IMI.0000000000000037
How-To-Do-It Article

The use of monitoring or device lines through the ascending aorta may be necessary for a variety of clinical situations. The technique provided in this article allows percutaneous closure of these entry sites with a closed chest.

From the *Divisions of Cardiothoracic and Vascular Surgery, Virginia Commonwealth University Medical Center, Richmond, VA USA; and †Virginia Commonwealth University, Richmond, VA USA.

Accepted for publication November 29, 2013.

Disclosure: The authors declare no conflicts of interest.

Address correspondence and reprint requests to Derek R. Brinster, MD, Divisions of Cardiothoracic and Vascular Surgery, Virginia Commonwealth University Medical Center, Medical College of Virginia Campus, West Hospital Building, 7th Floor, South Wing, 1200 East Broad St, PO Box 980068, Richmond VA 23298-0068 USA. E-mail:

Because of severe peripheral arterial disease, the cardiac surgeon may need to use the ascending aorta for placement of arterial monitoring lines or intra-aortic balloon pump (IABP). The use of the ascending aorta for placement of arterial lines or IABPs presents a challenge in postoperative management. Without the ability to safely remove these vital devices, the chest must be either left open or reopened when the devices are able to be removed.

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This technique was developed to allow primary chest closure and delayed removal of arterial sheaths and lines from the ascending aorta using a combination of devices. The critical portion of this procedure is the combined use of the AngioSeal closure device (St. Jude Medical, St Paul, MN USA) with the incorportation of the Ti-Knot (LSI Solutions, Victor, NY USA; Fig. 1). The use of just the AngioSeal is prone to failure because of the absence of an overlying fascia compartment, as is found in the leg. The Ti-Knot provides the additional force necessary to the AngioSeal collagen plug to remain affixed to the aorta.



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This method has been successfully used in more than six patients. One failure occurred because of an IABP rupture and subsequent inability to remove the IABP through the sheath, with removal of the unwrapped IABP causing a larger aortic defect that angioseal could not cover. Finger control was obtained at the bedside, and arterial repair was performed with minimally invasive instruments without opening the chest.


Aorta; Ascending aorta; Endovascular; Percutaneous

©2014 by the International Society for Minimally Invasive Cardiothoracic Surgery