Balloon Inflow Occlusion Technique For Precise Stent-graft Deployment In TEVAR
Suksan Kanoksin, Doctor1, Jongruk Kaewbunjong2.
1Chulabhorn Royal Academy, Bangkok, Thailand, 2Thammasat University Hospital, Bangkok, Thailand.
Abstract
Balloon Inflow Occlusion Technique for precise stent-graft deployment in TEVAR
BACKGROUND: The landing zone, which is one of the most important factors in endovascular surgery, should be long enough for efficient anchoring of the graft and to prevent endoleaks. Many techniques can be used to reduce blood pressure and stroke volume so that we can precisely deploy the graft at the landing zone. This study was to assure that the balloon occlusion technique is more efficient than using medicine to reduce blood pressure and stroke volume, thereby reducing the resistant force during stent-graft deployment in the TEVAR procedure. METHODS: We use the novel smallest aortic balloon occlusion catheter (Rescue balloon-Tokai Medical Products, Japan) placed percutaneously in the right femoral vein and the balloon tip located at the IVC-RA junction. We inflate the balloon with contrast normal saline (1:3) for 35 ml during TEVAR stent graft deployment to balloon occlude the IVC and reduce venous return to the heart. RESULTS: The intraoperative echocardiography measurement demonstrated that the stroke volume was reduced more in the balloon occlusion technique than when using vasodilator medication. The stent-graft was successfully deployed at the desired landing zone. During stent-graft deployment using the balloon inflow occlusion technique, the surgeon felt of low resistance and was at eased while made deployment. CONCLUSION: This study showed that the balloon inflow occlusion technique can effectively reduce stroke volume and blood pressure more than using vasodilator medication, so this technique could be used to help the surgeon make the precisely stent-graft deployment in the TEVAR procedure.
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