Challenging catheterization of a branch in an endovascular thoracoabdominal aneurysm repair.
OBJECTIVE
To describe a novel technique of cannulating a side branch during endovascular repair of a thoracoabdominal aneurysm (TAAA).


METHODS
The approach evolved during endovascular repair of a type III TAAA in which a custom-designed graft with 3 caudally directed branches was being deployed in a patient who had a prior surgical repair for a type IV TAAA. Two of the branches were successfully cannulated and stented, but repeated efforts to cannulate the left renal branch and artery via the standard brachial approach were unsuccessful. A catheter positioned between the graft and the aneurysm sac was used to gain retrograde access to this branch. From a left brachial access this guidewire was snared and used to allow bridging stent deployment between the branch and the renal artery, thus completing the procedure.


CONCLUSIONS
This report describes a novel technique to deal with challenging side branch cannulation that may be encountered during branched stent-graft deployment.
D'Elia
Piervito
P
Vascular Surgery, Hôpital Cardiologique, CHRU de Lille, France.
O'Brien
Noel
N
Sobocinski
Jonathan
J
Lerussi
Gilles
G
Perot
Celine
C
Azzaoui
Richard
R
Haulon
Stéphan
S
D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D002404:Catheterization / Q000295:instrumentation; D004867:Equipment Design; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012077:Renal Artery / Q000000981:diagnostic imaging; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome