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

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