Right Anterior Oblique-Based Approach for Managing Wire Wrap During Fenestrated TEVAR

The systematic approach to addressing "wire wrap" during f-TEVAR minimizes embolization and device distortion risks while optimizing procedural efficiency. This reproducible technique provides a valuable tool for advancing endovascular repair in challenging aortic arch pathologies.Clinical ImpactThis standardized technique for managing "wire wrap" during fenestrated thoracic endovascular aortic repair provides a reproducible and practical approach to a well-recognized intraoperative challenge. By systematizing wire handling, the technique enhances procedural safety and minimizes unplanned maneuvers that may increase operative time and radiation exposure while also facilitating device alignment and deployment in demanding scenarios. The innovation lies in offering a simple, easily adoptable strategy that can be consistently applied across operators and centers, supporting safer dissemination of complex endovascular techniques and promoting more predictable outcomes in advanced aortic repair.