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

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.