Balloon-grab technique to bridge steep renal artery during endovascular thoracoabdominal aortic aneurysm repair: technical note

Macech, Michał; Jakimowicz, Tomasz; Hammer, Piotr; Grochowiecki, Tadeusz; Nazarewski, Sławomir

doi:10.5603/aa.2017.0016

Cited by 2 publications

(2 citation statements)

References 14 publications

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“…Some authors describe the need for highly developed endovascular skills to overcome anatomical variants, perform complex secondary procedures, and address difficult situations that require bailout maneuvers, 5,6 describing the use of curved catheters or microcatheters and steerable sheaths, the balloon-grab technique, the use of aortic molding balloons, and the double guidewire-assisted technique as clever solutions to handle difficult situations. 6,13–16 In the current case, when the conflict of the bare stent prevented easy cannulation of the left renal artery, a longer and more tortuous pathway was chosen. In the search for a means to support and accurately reach a target vessel with unfavorable anatomy, we developed a “floating” stent-graft held distally by the struts of the bare stent.…”

Section: Discussionmentioning

confidence: 99%

Floating Stent-Graft as a Support to Bridge an Unfavorable Renal Artery During Postdissection TAAA Repair Using a Multibranched Thoracoabdominal Endograft

et al. 2020

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Purpose: To report an unusual endovascular technique to manage unfavorable renal artery anatomy encountered in an urgent case of symptomatic postdissection thoracoabdominal aortic aneurysm (TAAA) treated with an off-the-shelf multibranched device. Technique: The technique is demonstrated in a 77-year-old woman who had a history of previous open abdominal aortic aneurysm repair and an emergent procedure to implant a thoracic endograft and an aortic bare Z-stent (PETTICOAT) for acute Stanford type B dissection 7 years prior. The patient presented with a symptomatic, rapidly growing, postdissection TAAA. Endovascular treatment with a Zenith t-Branch was planned. After standard catheterization techniques failed in the left renal artery, a bailout maneuver was utilized to place a “floating” Viabahn stent-graft in the aneurysm sac to create sufficient support to deliver the bridging stent-grafts through the bare stent to the target left renal artery. The procedure was successful in excluding the TAAA and preserving perfusion to all target vessels. No neurological complications occurred. Six-month imaging follow-up confirmed the patency of the bridging stents. Conclusion: Remodeling changes after complex endovascular TAAA procedures often require the use of innovative techniques and materials during secondary procedures. In this case, the presence of a post-PETTICOAT bare aortic stent and hostile target artery anatomy increased the technical difficulty of t-Branch implantation. A “floating” stent-graft could be useful to reach challenging target vessels by providing additional support to bridging stent advancement and deployment.

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Section: Discussionmentioning

confidence: 99%

Floating Stent-Graft as a Support to Bridge an Unfavorable Renal Artery During Postdissection TAAA Repair Using a Multibranched Thoracoabdominal Endograft

et al. 2020

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“…The balloon was then inflated below the nominal pressure limit (5 atm) enabling safe exchange for a super stiff guidewire and subsequent easy placement of three 90-cm long hydrophilic-coated 7Fr guiding sheaths (Flexor Ansel, Cook Medical, Bloomington, IN, USA). [10][11][12][13][14][15] Following the standard fashion, using a Lunderquist Extra Stiff Wire Guide (Cook Medical, Bloomington, IN, USA), a 20Fr introducer sheath (Medtronic, Minneapolis, United-States) was placed in the left femoral artery and a 36 x 49 mm aortic extension (Endurant II, Medtronic, Minneapolis, United States) was deployed to cover the thoracic portion of the type IA endoleak zone aiming for 30% oversizing. The aortic graft was molded using a compliant balloon (Reliant balloon catheter, Medtronic, Minneapolis, United States).…”

Section: Part II -What Was Donementioning

confidence: 99%

A novel balloon-assisted technique to secure visceral catheterization during a chimney endovascular repair of a ruptured abdominal aortic aneurysm in a centenarian patient

Galastri,

Valle,

Cunha

et al. 2023

J. vasc. bras.

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A 100-year-old male patient was admitted with a ruptured abdominal aortic aneurysm due to type IA endoleak. Given the proximity of the ruptured site to the superior mesenteric artery (SMA) and renal arteries, a ChEVAR was indicated. Catheterization of the target visceral vessels was a challenging procedural step because of an intensely tortuous thoracic aorta. This hostile aortic anatomy also inhibited exchange for a super stiff guide-wire and selective cannulation with the diagnostic catheter was repeatedly lost when guidewire exchange was attempted. To overcome this issue, a 5 x 40 mm balloon catheter was placed 3cm into the target arteries. The balloon was then inflated below the nominal pressure limit enabling safe exchange for a super stiff guidewire and placement of three 90-cm long 7Fr guiding sheaths. The procedure was thus safely performed with deployment of an aortic extension and the bridging stents.

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Balloon-grab technique to bridge steep renal artery during endovascular thoracoabdominal aortic aneurysm repair: technical note

Abstract: The

Cited by 2 publications

References 14 publications

Floating Stent-Graft as a Support to Bridge an Unfavorable Renal Artery During Postdissection TAAA Repair Using a Multibranched Thoracoabdominal Endograft

Floating Stent-Graft as a Support to Bridge an Unfavorable Renal Artery During Postdissection TAAA Repair Using a Multibranched Thoracoabdominal Endograft

A novel balloon-assisted technique to secure visceral catheterization during a chimney endovascular repair of a ruptured abdominal aortic aneurysm in a centenarian patient

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