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A snare-assisted pull-up technique for side-branch component delivery during thoracic endovascular aortic repair for

Takehiro Suzuki¹, Takao Ohki¹, Kota Shukuzawa¹

¹Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.

Journal of Vascular Surgery Cases and Innovative Techniques

|October 17, 2026

Abstract:

We report a case of thoracic endovascular aortic repair using a thoracic branch endoprosthesis for aneurysm enlargement caused by an endoleak after prior fenestrated repair. A 75-year-old man with previous left subclavian artery stenting presented with aneurysm growth. Advancement of the side-branch component through the pre-existing stent was difficult because of severe angulation, and standard push-up techniques failed. A snare-assisted pull-up technique via a pre-existing 6F brachial sheath enabled direct capture and controlled pull-and-push advancement of the device. This method may serve as a simple bailout strategy for difficult branch component delivery.

Keywords:

Bailout strategy Brachial approach Side-branch component Snare-assisted technique Thoracic branch endoprosthesis

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