Stabilizing Technique for Bridging Stent Placement in Branched Endovascular Aortic Repair

Abstract

Purpose: To present a bailout technique for bridging covered stent placement during branched endovascular aortic repair (BEVAR) in complex anatomy. Technique: BEVAR is an alternative technique for the treatment of thoracoabdominal aortic aneurysms (TAAAs). Visceral and renal vessels must be preserved by bridging covered stent placement through downward-oriented branches of the main stent graft device. Challenging anatomy such as kinking and elongation of the aorta, or type III aortic arch configuration may impede successful catheterization of these branches due to reduced steerability and pushability of the endovascular material. Different alternative techniques have been described to overcome these anatomic barriers. This technical note adds another endovascular solution to complex cases using the guiding sheath stabilizing technique. It is based on a standard “through-and-through” technique. An attached snare is inserted via femoral approach, providing a stable position for branch catheterization and bridging covered stent deployment. Conclusion: The stabilizing technique is safe and easy to perform and provides a stable position of the guiding sheath when antegrade branch catheterization is challenging. This technique is an additional tool for handling challenging cases.