Transcaval Delivery of the Gore TAMBE Branched Endograft for Treatment of a Complex Aortic Aneurysm with Small Iliac Access

Endovascular repair of thoracoabdominal aortic aneurysm has been limited by the need for large iliac access or open iliac conduits. We describe a technique for transcaval delivery of the Gore thoracoabdominal multibranch endoprosthesis in a patient with unfavorable iliac anatomy. After femoral venous puncture, a controlled aortocaval tract is created with an electrified 0.014″ wire and serially dilated to allow insertion of a 22F Dryseal sheath into the abdominal aorta and deployment of the thoracoabdominal branch endoprosthesis delivery system. At procedure completion the aortocaval tract is then closed with a Gore Cardioform Septal Occluder.