How to Occlude a Side Branch on a Branched Stent-Graft During an Endovascular Thoracoabdominal Aortic Aneurysm Repair

Abstract

This technique should be known to any team performing TAAA repair with branched stent-grafts. It may also serve as a means of fitting a stent-graft to a different patient in an emergency setting, as in the case illustrated here.

The transition from custom-made to standardized multibranched thoracoabdominal aortic stent grafts

“…After all the branches had been placed, the redundant cuff was occluded using an Amplatzer II plug (AGA Medical Corporation, Plymouth, Minn), as described by Ferreira et al 12 Branch morphology. The study protocol required contrast-enhanced computed tomography angiography (CTA) before repair and at 1 week, 1 month, 6 months, 12 months, and annually thereafter.…”

Applicability and midterm results of branch cuff closure with vascular plug in branched endovascular repair for thoracoabdominal aortic aneurysms

“…After availability of the AVP-II, we discontinued using the AVP for this purpose, and the AVP-II became our preference when closing the branch cuffs. A plug was deployed inside the branch cuff using a standard deployment technique as described by Ferreira et al 4 (Fig 2, A). If accurate plug placement was difficult because of catheter instability, the branch cuffs were extended by placement of a peripheral stent graft, preferably a balloon-expandable stent graft, before the AVP-II was deployed (Fig 2, B).…”

“…In this scenario, we have found useful the extension of the branch cuff with a balloon-expandable stent graft, which not only facilitates deployment but also allows the use of the full length of the plug in the cuff to be occluded, achieving maximum sealing length by avoiding the protrusion of the discs outside of the branch cuff, as originally suggested. 4 The extension adds an extra cost but may have been one of the contributors to the effective and safe use of the device for this purpose.…”

“…Irrespective of the reason, a branch that is not bridged to a TV must be closed properly to prevent a persistent type III endoleak. In these cases, closure of the unused branch cuff with a vascular plug has been reported 4 and widely adopted, but no data have been reported for aneurysm-related outcomes. This study reports the results of consecutive cases where vascular plugs were used for branch closure in b-EVAR of TAAA.…”

Standardized Off-the-Shelf Components for Multibranched Endovascular Repair of Thoracoabdominal Aortic Aneurysms

“…Unfortunately, endovascular repair may have only mitigated the incidence of the complications rather than eliminated the problem entirely. 13 In fact, following endovascular repair, the primary determinant of spinal cord ischemia risk is the extent of aortic coverage. Thus, although the standardized designs for thoracoabdominal aneurysm repair as discussed above might be a speedy way to treat a type IV thoracoabdominal aneurysm, the amount of aortic coverage required by such a repair would expose the patient to an unnecessary risk of paraplegia.…”