Experience of Alternative Technique for Branch Cannulation in Branched Endovascular Aneurysm Repair

Background/Objectives: To describe our experience of using an alternative technique for retrograde branch graft cannulation during Branched EndoVascular Aortic Repair (B-EVAR) of complex abdominal and thoraco-abdominal aortic aneurysm (TAAA) with branched endografts. Methods: Data from patients who underwent B-EVAR for TAAA/complex abdominal aneurysms and in whom the cannulation of a branch was performed through a retrograde approach with our technique were retrospectively collected and analyzed. The technique consists of the placement of two 4F Ber catheters in both femoral arteries, which are advanced in parallel with the main graft before its deployment and left in the aneurysmal sac. These catheters are then used as a bailout for the retrograde cannulation of one or more branches of the endograft. Results: The technique was employed in 4 patients (1 female, 1 urgent) treated from 2018 onward, allowing the successful catheterization of 4 challenging branches that could not be catheterized using other approaches. The patients' mean age was 80.7 + 2.2 years. No intraoperative nor postoperative complications linked to the technique occurred. Conclusions: The placement of two catheters from both femoral arteries inside the aneurysmal sac before graft deployment can be safe and useful for bailout retrograde cannulation of any branch of the endograft, when other techniques fail.