Techniques in occluding the aorta during endovascular repair of ruptured abdominal aortic aneurysms Mark Edward O’Donnell, DSEM, MRCS, Stephen A. Badger,

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Presentation transcript:

Techniques in occluding the aorta during endovascular repair of ruptured abdominal aortic aneurysms Mark Edward O’Donnell, DSEM, MRCS, Stephen A. Badger, MB, MRCS, Ragai R. Makar, MSC, FRCS, Willie Loan, FRCR, Bernard Lee, FRCS, Chee V. Soong, MD, FRCS Journal of Vascular Surgery Volume 44, Issue 1, Pages 211-215 (July 2006) DOI: 10.1016/j.jvs.2006.03.033 Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 1 The sheath-over-balloon technique. A, A long introducer and 16F sheath is inserted over a guidewire through the contralateral femoral artery into the aneurysm sac either percutaneously or after surgical exposure. An angiocatheter is inserted simultaneously into the ipsilateral femoral artery. B, When the top of the sheath is in the aneurysm sac the introducer is removed and a large 30-mL balloon is passed through the sheath until it is beyond the top end of the sheath in the aneurysm sac. C, The balloon is inflated and then withdrawn until it lodges against the top end of the sheath. D, The sheath is then advanced with the balloon until it abuts against the shoulder of the aneurysm neck from below. Journal of Vascular Surgery 2006 44, 211-215DOI: (10.1016/j.jvs.2006.03.033) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 2 Intraoperative radiograph demonstrates inflated Reliant balloon passed via the contralateral femoral artery lodged against the top of the sheath, abutting the shoulder of the aneurysm neck from below. A calibration catheter is passed via the ipsilateral side. This will be exchanged for a stiff wire to facilitate passage of the stent-graft system. Journal of Vascular Surgery 2006 44, 211-215DOI: (10.1016/j.jvs.2006.03.033) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 3 The balloon-ahead-of-graft technique. A, The stent-graft system is advanced into the aneurysm sac over a guidewire. B, The balloon can be advanced proximally into the descending aorta without moving the stent graft within the sheath, between 5 cm and 10 cm above the top of sheath. C, The balloon is then inflated in the suprarenal aorta. The position of the balloon can be maintained by holding the shaft of the delivery system. D, The stent is deployed with placement of the first uncovered portion across the renal arteries and then the first covered portion at a level immediately distal to the lower renal artery ostia. Journal of Vascular Surgery 2006 44, 211-215DOI: (10.1016/j.jvs.2006.03.033) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 4 Intraoperative angiogram performed through a side-port of the sheath demonstrates renal arteries after stent deployment with balloon still inflated. Journal of Vascular Surgery 2006 44, 211-215DOI: (10.1016/j.jvs.2006.03.033) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions