How to Occlude a Side Branch on a Branched Stent-Graft during an Endovascular Thoracoabdominal Aortic Aneurysm Repair

Abstract

Purpose:

To present a means of occluding an unneeded side branch during deployment of custom-made branched stent-grafts for thoracoabdominal aortic aneurysm (TAAA) repair.

Technique:

When a side branch on a customized TAAA branched stent-graft is not needed, an oversized Amplatzer Vascular Plug II can be deployed inside the side branch after the other visceral artery branches have been deployed. The plug's distal disk is placed into the side branch from the aortic lumen, as though it were a bottle cap. Pulling the device backward deploys the remainder of the body inside the 18-mm-long side branch. The result is immediate and satisfactory.

Conclusion:

This technique should be known to any team performing TAAA repair with branched stent-grafts. It may also serve as a means of fitting a stent-graft to a different patient in an emergency setting, as in the case illustrated here.

Keywords

thoracoabdominal aneurysm thoracic endovascular aortic repair stent-graft side branch branched stent-graft

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References

Chuter

Gordon

Reilly

. An endovascular system for thoracoabdominal aortic aneurysm repair. J Endovasc Ther. 2001;8:25–33.

Ferreira

Lanziotti

Monteiro

Branched devices for thoracoabdominal aneurysm repair: early experience. J Vasc Surg. 2008;48 (6 Suppl):30S–36S.

Chuter

Rapp

Hiramoto

. Endovascular treatment of thoracoabdominal aortic aneurysms. J Vasc Surg. 2008;47:6–16.

Glatz

Petit

Gillespie

. Novel use of a modified Amplatzer Vascular Plug to occlude a patent ductus arteriosus in two patients. Catheter Cardiovasc Interv. 2008;72:82–86.

Jang

Son

Lee

. Transcatheter occlusion of a modified Blalock-Taussig shunt using the Amplatzer vascular plug with the catheter-snare technique. Pediatr Cardiol. 2008;29:670–672.

Karagoz

Ozkutlu

Celiker

Percutaneous closure of a prenatally diagnosed large coronary artery fistula with an Amplatzer vascular plug immediately after delivery. Acta Cardiol. 2008;63:405–408.

Kassaian

Alidoosti

Sadeghian

. Transcatheter closure of a coronary fistula with an Amplatzer vascular plug: should a retrograde approach be standard? Tex Heart Inst J. 2008;35:58–61.

Mangini

Lagana

Fontana

. Use of Amplatzer Vascular Plug (AVP) in emergency embolisation: preliminary experience and review of literature. Emerg Radiol. 2008;15:153–160.

Diehm

Kickuth

Silvestro

. Endovascular treatment of an internal iliac artery aneurysm using a nitinol vascular occlusion plug. J Endovasc Ther. 2005;12:616–619.

10.

Puppala

Wood

Initial clinical experience using the Amplatzer vascular plug. Cardiovasc Intervent Radiol. 2008;31:444–445.

11.

Ratnam

Walkden

Munneke

. The Amplatzer vascular plug for large vessel occlusion in the endovascular management of aneurysms. Eur Radiol. 2008;18:2006–2012.

12.

Chaudhuri

Tibballs

Nadkarni

. Digital embolization due to partially uncovered left subclavian artery post TEVAR: management with Amplatzer vascular plug occlusion. J Endovasc Ther. 2007;14:257–259.

13.

Vandy

Criado

Upchurch

. Transluminal hypogastric artery occlusion with an Amplatzer vascular plug during endovascular aortic aneurysm repair. J Vasc Surg. 2008;48:1121–1124.

14.

White

Travis

. The Amplatzer vascular plug. Cardiovasc Intervent Radiol. 2008;31:448–449.

15.

Sweet

Hiramoto

Ki-Hyuk Park

. A standardized multi-branched thoracoabdominal stent-graft for endovascular aneurysm repair. J Endovasc Ther. 2009;16:359–364.