Challenging catheterization of a branch in an endovascular thoracoabdominal aneurysm repair

To describe a novel technique of cannulating a side branch during endovascular repair of a thoracoabdominal aneurysm (TAAA).

The approach evolved during endovascular repair of a type III TAAA in which a custom-designed graft with 3 caudally directed branches was being deployed in a patient who had a prior surgical repair for a type IV TAAA. Two of the branches were successfully cannulated and stented, but repeated efforts to cannulate the left renal branch and artery via the standard brachial approach were unsuccessful. A catheter positioned between the graft and the aneurysm sac was used to gain retrograde access to this branch. From a left brachial access this guidewire was snared and used to allow bridging stent deployment between the branch and the renal artery, thus completing the procedure.

This report describes a novel technique to deal with challenging side branch cannulation that may be encountered during branched stent-graft deployment.