Balloon-Assisted Distal Control for Open Thoracoabdominal Aortic Repair After Endovascular Aortic Repair

OBJECTIVE: To describe a feasible distal control technique using occlusion balloons during open thoracoabdominal aortic repair after endovascular aortic repair. KEY STEPS: A 76-year-old man with a thoracoabdominal aneurysm after endovascular aortic repair underwent hybrid open conversion. Under fluoroscopic guidance, 12-F introducer sheaths were placed, allowing insertion of occlusion balloons into each endograft limb to secure distal aortic control while maintaining distal perfusion through sheath side branches. Reconstruction included proximal anastomosis at Th9 and distal anastomosis to the previous endograft using a composite graft. POTENTIAL PITFALLS: Balloon migration, incomplete sealing, ischemic complications, and stent graft deformation require continuous hemodynamic and imaging guidance. TAKE-HOME MESSAGE: Balloon-assisted distal control facilitates distal anastomosis and allows immediate hybrid bailout when bleeding occurs.