Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.202300182
Jornal Vascular Brasileiro
Therapeutic Challenge

A novel balloon-assisted technique to secure visceral catheterization during a chimney endovascular repair of a ruptured abdominal aortic aneurysm in a centenarian patient

Uma nova técnica assistida por balão para assegurar a cateterização visceral durante o reparo endovascular, com a técnica de chaminé, de um aneurisma de aorta roto em um paciente centenário

Francisco Leonardo Galastri; Leonardo Guedes Moreira Valle; Marcela Juliano Silva Cunha; Bruno Pagnin Schmid; Rodrigo Gobbo Garcia; David Salomão Lewi; Breno Boueri Affonso; Felipe Nasser

Downloads: 2
Views: 501

Abstract

A 100-year-old male patient was admitted with a ruptured abdominal aortic aneurysm due to type IA endoleak. Given the proximity of the ruptured site to the superior mesenteric artery (SMA) and renal arteries, a ChEVAR was indicated. Catheterization of the target visceral vessels was a challenging procedural step because of an intensely tortuous thoracic aorta. This hostile aortic anatomy also inhibited exchange for a super stiff guide-wire and selective cannulation with the diagnostic catheter was repeatedly lost when guidewire exchange was attempted. To overcome this issue, a 5 x 40 mm balloon catheter was placed 3cm into the target arteries. The balloon was then inflated below the nominal pressure limit enabling safe exchange for a super stiff guidewire and placement of three 90-cm long 7Fr guiding sheaths. The procedure was thus safely performed with deployment of an aortic extension and the bridging stents.

Keywords

endoleak, abdominal aortic aneurysm, endovascular procedure, aneurysm, ruptured, aged, 80 and over, case report

Resumo

Um paciente de 100 anos foi diagnosticado com um aneurisma de aorta abdominal roto por um endoleak 1A. Pela proximidade do ponto de ruptura com a artéria mesentérica superior (AMS) e as artérias renais, um ChEVAR foi indicado. A cateterização das artérias-alvo foi um passo desafiador pela intensa tortuosidade da aorta torácica. Essa anatomia aórtica hostil também impediu a troca por um fio-guia extra-rígido, e a cateterização seletiva foi repetidamente perdida quando a troca de fio-guia foi tentada. Para superar essa dificuldade, um cateter balão 5mm x 40mm foi posicionado nas artérias-alvo. O balão foi, então, insuflado abaixo da pressão nominal, permitindo uma troca segura do fio-guia por um fio-guia extra-rígido e o posicionamento de três bainhas longas 7Frx 90cm. Assim, o procedimento foi executado de forma segura, com o implante de uma extensão aórtica e dos stents recobertos.
 

Palavras-chave

endoleak, aneurisma de aorta abdominal, procedimentos endovasculares, aneurisma roto, idoso de 80 anos ou mais

References

1 IMPROVE Trial Investigators. Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial. BMJ. 2014;348:f7661. http://dx.doi.org/10.1136/bmj.f7661.

2 Sonesson B, Björses K, Dias N, et al. Outcome after ruptured AAA repair in octo- and nonagenarians in Sweden 1994-2014. Eur J Vasc Endovasc Surg. 2017;53(5):656-62. http://dx.doi.org/10.1016/j.ejvs.2017.02.010. PMid:28356210.

3 Greenberg RK, Clair D, Srivastava S, et al. Should patients with challenging anatomy be offered endovascular aneurysm repair? J Vasc Surg. 2003;38(5):990-6. http://dx.doi.org/10.1016/S0741-5214(03)00896-6. PMid:14603205.

4 Patel RP, Katsargyris A, Verhoeven ELG, Adam DJ, Hardman JA. Endovascular aortic aneurysm repair with chimney and snorkel grafts: indications, techniques and results. Cardiovasc Intervent Radiol. 2013;36(6):1443-51. http://dx.doi.org/10.1007/s00270-013-0648-5. PMid:23674274.

5 Jernigan EG, Nguyen Tran N, Qato K, Giangola G, Carroccio A, Conway AM. Outcomes of chimney/snorkel endovascular repair for symptomatic and ruptured abdominal aortic aneurysms. J Vasc Surg. 2021;74(4):1117-24. http://dx.doi.org/10.1016/j.jvs.2021.03.025. PMid:33848555.

6 Torsello G, Usai MV, Scali S, et al. Gender-related outcomes of chimney EVAR within the PERICLES registry. Vascular. 2018;26(6):641-6. http://dx.doi.org/10.1177/1708538118797448. PMid:30205781.

7 Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018;67(1):2-77.e2. http://dx.doi.org/10.1016/j.jvs.2017.10.044. PMid:29268916.

8 Criado FJ. Chimney grafts and bare stents: aortic branch preservation revisited. J Endovasc Ther. 2007;14(6):823-4. http://dx.doi.org/10.1583/07-2247.1. PMid:18052599.

9 Nasser F, Silva RO, Ingrund JC, et al. Implante de endoprótese aórtica através de acesso totalmente percutâneo. J Vasc Bras. 2009;8(2):182-5. http://dx.doi.org/10.1590/S1677-54492009000200014.

10 Peeling L, Fiorella D. Balloon-assisted guide catheter positioning to overcome extreme cervical carotid tortuosity: technique and case experience. J Neurointerv Surg. 2014;6(2):129-33. http://dx.doi.org/10.1136/neurintsurg-2013-010655. PMid:23471076.

11 Shibuya K, Koike N, Mohara J, Takahashi T, Tsushima Y. Anchor balloon technique: balloon-assisted guiding sheath or catheter advancement to overcome iliac artery tortuosity for embolization using vascular plugs. Vasc Endovascular Surg. 2017;51(2):87-90. http://dx.doi.org/10.1177/1538574416689423. PMid:28103753.

12 Macech M, Jakimowicz T, Hammer P, Grochowiecki T, Nazarewski S. Balloon-grab technique to bridge steep renal artery during endovascular thoracoabdominal aortic aneurysm repair: technical note. Acta Angiol. 2017;23(4):159-62. http://dx.doi.org/10.5603/AA.2017.0016.

13 Lowell Kahn S. Balloon anchor techniques for sheath, guide catheter, and stent advancement and to facilitate chronic total occlusion traversal. In: Lowell Kahn S, Arslan B, Masrani A, editors. Interventional and endovascular tips and tricks of the trade. New York: Oxford Academic; 2018. p. 275-280.

14 Heidemann F, Panuccio G, Tsilimparis N, et al. Balloon-anchoring technique to stabilize target vessel catheterization in complex endovascular aortic repair. J Endovasc Ther. 2020;27(2):248-51. http://dx.doi.org/10.1177/1526602819900989. PMid:31989858.

15 Miyoshi K, Akamatsu Y, Kojima D, et al. Balloon-hooking technique for stabilizing a guiding catheter in tortuous supra-aortic vessel: a case report. Radiol Case Rep. 2022;17(10):3966-70. http://dx.doi.org/10.1016/j.radcr.2022.07.086. PMID: 35991386.

16 Simonte G, Isernia G, Fino G, et al. Ceiling technique to facilitate target vessel catheterization during complex aortic repair. Ann Vasc Surg. 2021;71:528-32. http://dx.doi.org/10.1016/j.avsg.2020.09.011. PMid:32950625.

17 Ferreira M, Katsargyris A, Rodrigues E, et al. “Snare-Ride”: a bailout technique to catheterize target vessels with unfriendly anatomy in branched endovascular aortic repair. J Endovasc Ther. 2017;24(4):556-8. http://dx.doi.org/10.1177/1526602817709465. PMid:28514896.

18 Sheikh Z, Crockett S, Selvakumar S. Endovascular aneurysm repair in a centenarian: case report and systematic literature review. J Surg Case Rep. 2020;2020(4):rjaa025. http://dx.doi.org/10.1093/jscr/rjaa025.
 


Submitted date:
02/12/2023

Accepted date:
05/09/2023

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
654e2228a95395067e482ca3 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections