Journal of Angiology & Vascular Surgery Category: Medical Type: Case Report
Balloon Assisted Technique in Peripheral Interventions: A Useful Tool
- Pozzi Mucelli Fabio1, Pozzi Mucelli Roberta Antea1*, Sacconi Francesca1, Braini Massimiliano1, Belgrano Manuel Gianvalerio1, Cova Maria Assunta1
- 1 Department Of Radiology, Azienda Sanitaria Universitaria Integrata Di Trieste, Trieste, Italy
*Corresponding Author:Pozzi Mucelli Roberta Antea
Department Of Radiology, Azienda Sanitaria Universitaria Integrata Di Trieste, Trieste, Italy
Received Date: Mar 28, 2019 Accepted Date: May 03, 2019 Published Date: May 10, 2019
Balloon Assisted Technique (BAT) consists in the use of a balloon catheter advanced in a parallel fashion to main catheter in the same artery to overcome problems during endovascular interventions. We describe three different cases of BAT. The first case is an example of pancreatic-duodenal artery aneurysm treated with a flow-diverter stent; in the second case BAT was used to help the advancement of a covered stent in the renal artery during a “Chimney” deployment in an advanced EVAR procedure. The third case BAT allowed improving visibility and catheterization of a diaphragmatic artery feeding a small HCC during TACE procedure.
These are some possible applications of BAT technique. More than a technique we believe that BAT is a “maneuver” to be tailored for every complex situation with specific materials.
Abdominal aortic aneurysm treated with parallel stent grafting technique. Male, 75 yrs an asymptomatic juxtarenal abdominal aortic aneurysm of 5 cm of maximum diameter, was detected during abdominal US performed for unrelated pathology. CT-angiography confirmed the lesion starting just below the origin of SMA and involving both renal arteries. Patient preferred to be treated immediately instead of undergoing an imaging surveillance. An advanced EVAR treatment was planned with “parallel” stenting of both renal arteries and SMA because at that time this was our first choice of treatment for these type aneurysms. After surgical cut-down of the axillary artery two long introducer-sheaths were advanced, one in SMA and one in left renal artery. Right renal artery was approached from one of two femoral accesses; however advancement of stiff guidewire (Amplatz Super stiff-Boston) was problematic due to unfavorable angle. For this reason we decided to inflate an occlusion balloon (Reliant Medtronic) just over the origin of renal arteries while advancing the stiff wire in the right renal artery (Figure 2a) and after this, with the same modality, a 7F long introducer sheath (Destination Terumo) was introduced inside the artery (Figure 2b). After correct positioning of all sheaths the balloon covered stents were advanced and deployed at the origin of target vessels and EVAR treatment was completed as usual (Figure 2b).
Transarterial Chemoembolization (TACE) for Hepatocellular Carcinoma (HCC) with atypical feeding artery. Male, 68 yrs History of HCC treated with multiple chemoembolization procedures. At CT follow-up an incomplete response was detected in a nodule of the 7th segment and a feeding artery supplied by right diaphragmatic artery was suspected. Selective angiography of celiac trunk was done but visualization of right diaphragmatic artery was faint. To increase visibility of this artery a second femoral access was done and a balloon catheter inflated in the proximal celiac trunk improving detection of right diaphragmatic artery which was then easily catheterized. Selective injection confirmed feeding artery to the 7th segment HCC nodule and TACE procedure could be done.
CONFLICT OF INTEREST
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Citation: Pozzi Mucelli F, Pozzi Mucelli RA, Sacconi F, Braini M, Belgrano MG, Cova MA (2019) Balloon Assisted Technique in Peripheral Interventions: A Useful Tool. J Angiol Vasc Surg 4: 022.
Copyright: © 2019 Pozzi Mucelli Fabio, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.