Partial right atrial inflow occlusion for controlled systemic hypotension during thoracic endovascular aortic repair

Controlled hypotension is sometimes necessary for accurate endograft deployment and adjunctive ballooning and stenting near the arch and proximal descending thoracic aorta. This article describes a technique in which a compliant occlusion balloon inflated in the right atrium is used to occlude the inflow from the inferior vena cava and reduce the cardiac preload. This reliably and effectively induces systemic hypotension to any desired level and is also able to be rapidly reversed. The technique has been used in 11 cases of thoracic endovascular aortic repairs with complete success and no procedure-related complications.