Retrograde catheterization of the SMA on a B-EVAR – Case report

Endovascular treatment of complex thoracoabdominal aneurysms with branched and fenestrated grafts (B/F-EVAR) has become the first option for patients with suitable anatomy and very high risk for open surgery, who would likely be refused for open repair. We present a case of a patient with a type III thoracoabdominal aneurysm submitted to endovascular repair with a custom-made endograft with branches to the celiac trunk and SMA, and a fenestration to the left renal artery. During the procedure there was the need to do a laparotomy to allow for retrograde catheterization of the SMA, with technical success. In this case, the retrograde access was of utmost importance for the completion of the procedure. Different techniques for target vessel catheterization, such as the one we describe, should be part of a vascular surgeon's resources in B/F-EVAR procedures.