Combined Pull through and Balloon Anchoring Bailout Technique to Repair a Failed Bifurcated Endovascular Aortic Repair

Background: To describe a bailout technique used to manage the left stump of a bifurcated endograft that was stuck above a narrowed distal aortic neck. Methods: An 80-year-old man with a suprarenal aneurysm was treated with a custom-made 4vessel fenestration endograft. During the procedure, the left stump of the distal bifurcated graft module was chased out of a narrow distal aortic neck and became stuck horizontally at the bottom of the aortic aneurysmal sac. Through a femoral to left subclavian artery through-andthrough percutaneous access, a balloon-anchoring technique was successfully used to return the endograft stump into the narrowed aortic neck and exclude the aneurysm. Conclusions: The combined technique of a through-and-through and anchoring balloon was found to be suitable for introducing an endograft limb into a narrow distal aortic neck.