Technique of supraceliac balloon control of the aorta during endovascular repair of ruptured abdominal aortic aneurysms

Berland TL, Veith FJ, Cayne NS, et al (New York Univ Langone Med Ctr; et al) J Vasc Surg 57:272-275, 2013^§

Abstract

Endovascular aneurysm repair is being used increasingly to treat ruptured abdominal aortic aneurysms (RAAAs). Approximately 25% of RAAAs undergo complete circulatory collapse before or during the procedure. Patient survival depends on obtaining and maintaining supraceliac balloon control until the endograft is fully deployed. This is accomplished with a sheath-supported compliant balloon inserted via the groin contralateral to the side to be used for insertion of the endograft main body. After the main body is fully deployed, a second balloon is placed within the endograft, and the first balloon is removed so that extension limbs can be placed in the contralateral side. A third balloon can be placed via the contralateral side and ipsilateral extensions deployed as necessary. This technique of supraceliac balloon control is important to achieving good outcomes with RAAAs. In addition to minimizing blood loss, this technique minimizes visceral ischemia and maintains aortic control until the aneurysm rupture site is fully excluded (Fig).

Figure A, Supraceliac balloon control via a large contralateral sheath. B, Main body of endograft is deployed via ipsilateral access. Slight temporary deflation of the balloon may be required to allow for passage of the tip of the device. C, After the endograft body and ipsilateral limb are deployed, a second balloon is placed via the ipsilateral groin and inflated within the main body of the graft, maintaining continuous aortic control. D, The contralateral gate is cannulated and the contralateral limb is deployed while maintaining balloon control from the ipsilateral side. E, To allow for extension of the ipsilateral limb without losing aortic control, a third balloon is placed through the contralateral groin, maintaining wire access on the ipsilateral side. F, With the third balloon still inflated via the contralateral groin, the ipsilateral limb is extended to allow for a distal seal. The balloon is then deflated and angiography is performed (see text for details). (Reprinted from the Journal of Vascular Surgery. Berland TL, Veith FJ, Cayne NS, et al. Technique of supraceliac balloon control of the aorta during endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg. 2013;57:272-275, Copyright 2013, with permission from the Society for Vascular Surgery.)

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