Emergency Endovascular Stent Grafting of an Innominate Vein Injury Causing Hemothorax: The Double Balloon on a Single Wire Technique.

Abstract

Purpose: The VIABAHN^® VBX is a versatile stent graft that can be overdilated by up to 30% of its nominal diameter. However, to reach its maximum diameter, the balloon must be exchanged for a larger one. This technical note aims to illustrate a technique designed to enhance accuracy during the deployment and overdilation of a VIABAHN VBX for treating an injury to the left innominate vein (LIV).

Technique: Two venous accesses were established in the left arm and in the right femoral vein. Using a rendezvous technique, a hydrophilic guidewire was snared and externalized from the arm. The balloon-expandable stent was advanced through the brachial access, and the larger balloon from the femoral access, both on the same guidewire. The balloon-expandable stent was inflated to its maximum diameter. During the retraction of the first balloon, the larger balloon was then advanced within the stent graft to perform overdilation.

Results: The defect in the LIV was sealed-off without stent-graft migration and the patient showed improvement in his clinical condition.

Conclusion: The VIABAHN VBX is a valid option for treating injuries to the LIV. The double-balloon on a single wire (double-BLOW) technique may be an advantageous approach to prevent migration and enhance accuracy during deployment.Clinical ImpactThe double-BLOW technique offers improved stability and enhanced precision in deliver stent grafts and it might be useful when a larger balloon is required to perform over dilatation.