Korean J Radiol.  2015 Aug;16(4):744-748. 10.3348/kjr.2015.16.4.744.

Balloon-Supported Passage of a Stent-Graft into the Aortic Arch

• Eun NL
• Lee D
• Song SW
• Joo SM
• Kolbel T
• Lee KH

• KMID: 2155547
• DOI: http://doi.org/10.3348/kjr.2015.16.4.744

Abstract

A 62-year-old man was admitted, and thoracic endovascular aortic repair (TEVAR) procedure was performed to treat an accidentally detected aortic aneurysm, which was 63 mm in diameter. While performing TEVAR, the passage of the stent-graft introducer system was impossible due to the prolapse of the introducer system into a wide-necked aneurysm; this aneurysm was located at the greater curvature of the proximal descending thoracic aorta. In order to advance the introducer system, a compliant balloon was inflated. Thus, we created an artificial wall in the aneurysm with this inflated balloon. Finally, we were able to advance the introducer system into the target zone.

Keyword

Thoracic aortic aneurysm; Thoracic endovascular aortic repair; Wide-necked aneurysm; Proximal descending thoracic aorta; Aortic arch; Balloon-supported passage of an introducer system

MeSH Terms

*Angioplasty, Balloon
Angioplasty, Balloon, Coronary/*methods
Aortic Aneurysm, Thoracic/radiography/*surgery
Blood Vessel Prosthesis Implantation/*methods
Endovascular Procedures/*methods
Humans
Male
Middle Aged
*Stents
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Balloon-supported passage of stent graft. A. Morphology and location of aneurysm. CT-angiography with three-dimensional reconstruction of thoracic aorta revealed large saccular aneurysm of 63 mm in diameter at greater curvature of proximal descending thoracic aorta, which is just behind orifice of left subclavian artery. Sequential steps of procedure. B. Although guidewire was extra stiff, introducer prolapsed into aneurysm sac due to lack of support at greater curvature (wide neck of aneurysm at greater curvature side). Note prolapsed extra stiff guidewire and pigtail catheter into aneurysm sac. C. Owing to support created by inflated occlusion balloon, we gently advanced introducer system of stent-graft. Note that inflated occlusion balloon (arrows) creates artificial wall of appropriate size at greater curvature side; this does not stress aneurysm wall. D. Advancement of introducer system was successfully performed at target zone by pulling down (inferior) occlusion balloon. While operator pushes up introducer system, assistant pulls down occlusion balloon. Note that sliding support repositions inflated balloon (arrows) upward. E. Introducer system could be advanced into aortic arch. Note occlusion balloon inside aneurysm sac adjacent to introducer system. F. In two-year follow-up period, we performed CT with three-dimensional (3D) reconstruction of thoracic aorta. 3D CT scan revealed good positioning of Zone 2 thoracic endovascular aortic repair stent-graft, patent left subclavian artery bypass graft, complete occlusion and shrinkage of saccular aneurysm.

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