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Case Reports
. 2022 Oct 21;8(4):894-896.
doi: 10.1016/j.jvscit.2022.08.027. eCollection 2022 Dec.

Tightrope Technique for facilitating complex endovascular aortic repair in patients with severely angulated neck

Michael D Spinosa  1 , Joshua D Adams  1   2
Affiliations
Case Reports

Tightrope Technique for facilitating complex endovascular aortic repair in patients with severely angulated neck

Michael D Spinosa et al. J Vasc Surg Cases Innov Tech. .

Abstract

An 84-year-old presented with a large, symptomatic juxtarenal abdominal aortic aneurysm. Owing to severe angulation of the infrarenal neck, advancement of the distal bifurcated component caused dramatic lateral movement of the proximal physician-modified endovascular graft (PMEG) fenestrated device. This procedure risked aneurysm sac perforation and possible PMEG device displacement. To avoid this complication, the distal aspect of the PMEG device was tethered in place using endoscopic forceps to provide countertraction, similar to pulling a tightrope. This technique allowed for the uneventful placement of the distal bifurcated component without complication. This technique can overcome device placement challenges within an angulated aorta caused by large aneurysms.

Keywords: AAA; Forceps providing countertraction; Infrarenal aortic angulation; PMEG; Tightrope technique.

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Figures

Fig
Fig
Angiogram image of successful branched endovascular repair of the juxtarenal aortic artery aneurysm, right common iliac artery aneurysm, and left internal iliac artery aneurysm.
See this image and copyright information in PMC

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