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The Balloon-Pushing Technique to Rescue a Covered Hypogastric Artery During Endovascular Aortic Repair
Jose I Torrealba1, Giuseppe Panuccio1, Petroula Nana1
1German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg Eppendorf, Hamburg, Germany.
Introduction:
The coverage of a hypogastric artery (HA) may lead to several complications, such as gluteal claudication, erectile dysfunction, and even a higher risk of spinal cord ischemia in complex aortic repair. It has been shown to occur in 1% to 8% of endovascular aortic repair. We present the balloon-pushing technique to rescue an HA after its overstenting by an iliac limb.
Technique:
After the HA overstenting, a 20 Fr sheath was kept close to the distal edge of the iliac limb. A stiff wire was kept in place and a 12×40 mm balloon was inflated at the overlapping between the iliac limb and the main endograft. Then, the balloon shaft was vigorously pushed, creating a posterior and superior movement of the iliac limb, that ended up freeing the HA origin.
Conclusion:
The balloon-pushing technique is a simple technique to rescue the HA after its coverage by an iliac limb. Patient anatomy and knowledge of the endografts must be carefully considered.Clinical ImpactThe balloon-pushing technique is a simple technique to rescue the hypogastric artery after its coverage by an iliac limb. Despite its simplicity the technique has not been previously described. We believe it should be used as first manouver to rescue the hypogastric artery if covered by 5-10 mm.
