Sequential Catheterization and Progressive Deployment of the Zenith® t-Branch™ Device for Branched Endovascular Aortic Aneurysm Repair

Purpose: To describe a sequential deployment technique of the Zenith® t-Branch™ device for branched endovascular aortic aneurysm repair that might reduce potential rotation and increases optimal positioning of the device. Technique: After obtaining bilateral groin and right brachial access, the device is advanced over a through-and-through brachio-femoral guidewire and positioned based on prior measurements and landmarks. The t-Branch device is deployed one branch at a time and each visceral branch is sequentially catheterized from brachial access using live CT-fusion and intravascular ultrasound guidance. Full deployment prior to branch catheterization is avoided to maintain device stability, reduced spontaneous rotation, wider working room and freedom in positioning of the device while target artery catheterization is secured. Conclusion: Sequential catheterization amid progressive deployment of the Zenith® t-Branch™ device is an effective method of deployment of the device that ensures optimal positioning and secured catheterization of the target vessels.