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Vol 23, No 4 (2017)
Case report
Published online: 2017-12-28
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Balloon-grab technique to bridge steep renal artery during endovascular thoracoabdominal aortic aneurysm repair: technical note

Michał Macech1, Tomasz Jakimowicz1, Piotr Hammer2, Tadeusz Grochowiecki1, Slawomir Nazarewski1
DOI: 10.5603/AA.2017.0016
·
Acta Angiologica 2017;23(4):159-162.
Affiliations
  1. Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Banacha 1a St., 02-097 Warsaw, Poland
  2. Cook Medical Consultant, Warsaw, Poland

open access

Vol 23, No 4 (2017)
Case reports
Published online: 2017-12-28

Abstract

The aim of the study is to describe an endovascular manoeuvre that can help in the cannulation and stenting of difficult renal arteries in endovascular thoracoabdominal aortic aneurysm exclusion (EVAR) with a branched stent graft. Routinely, dedicated branch and target vessels are cannulated in antegrade fashion through a transaxillary approach. If renal arteries are steep, tortuous, and unfavourable, cannulation failure can preclude a successful endovascular procedure. In that situation, the guidewire slips off the artery. However, another guidewire and balloon can be introduced to the target vessel through femoral access. Expansion of an additional percutaneous transluminal angioplasty (PTA) balloon in the target vessel grabs the guidewire or catheter cannulated in typical fashion and prevents it from slipping off. At this point, a stiffer wire can be introduced, and the covered stent easily bridges the target vessel. The rest of the procedure is continued typically. Expansion of an additionally introduced balloon allows the surgeon to grab the guidewire in the renal artery, thus excluding an aneurysm during EVAR. Our early experience shows that this method is effective and durable.

Abstract

The aim of the study is to describe an endovascular manoeuvre that can help in the cannulation and stenting of difficult renal arteries in endovascular thoracoabdominal aortic aneurysm exclusion (EVAR) with a branched stent graft. Routinely, dedicated branch and target vessels are cannulated in antegrade fashion through a transaxillary approach. If renal arteries are steep, tortuous, and unfavourable, cannulation failure can preclude a successful endovascular procedure. In that situation, the guidewire slips off the artery. However, another guidewire and balloon can be introduced to the target vessel through femoral access. Expansion of an additional percutaneous transluminal angioplasty (PTA) balloon in the target vessel grabs the guidewire or catheter cannulated in typical fashion and prevents it from slipping off. At this point, a stiffer wire can be introduced, and the covered stent easily bridges the target vessel. The rest of the procedure is continued typically. Expansion of an additionally introduced balloon allows the surgeon to grab the guidewire in the renal artery, thus excluding an aneurysm during EVAR. Our early experience shows that this method is effective and durable.

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Keywords

thoracoabdominal aneurysm, endovascular aneurysm repair, renal artery, urgent procedure, off-the-shelf device

About this article
Title

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

Journal

Acta Angiologica

Issue

Vol 23, No 4 (2017)

Article type

Case report

Pages

159-162

Published online

2017-12-28

Page views

1101

Article views/downloads

1368

DOI

10.5603/AA.2017.0016

Bibliographic record

Acta Angiologica 2017;23(4):159-162.

Keywords

thoracoabdominal aneurysm
endovascular aneurysm repair
renal artery
urgent procedure
off-the-shelf device

Authors

Michał Macech
Tomasz Jakimowicz
Piotr Hammer
Tadeusz Grochowiecki
Slawomir Nazarewski

References (15)
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