Balloon guidance for superior mesenteric artery scallop alignment during Cook Zenith Fenestrated AAA Endovascular Graft deployment

To achieve seal, aortic endografts may require coverage of the aorta adjacent to or involving critical branch vessels. One technique for maintaining branch vessel patency at the leading edge of an endograft is use of a scallop. However, it may be difficult to ensure proper scallop alignment both before and after endograft deployment. We describe a technique for improving superior mesenteric artery scallop alignment of the Cook Zenith Fenestrated AAA Endovascular Graft (Cook Medical, Bloomington, Ind) using scallop precannulation and ostial superior mesenteric artery balloon inflation during both diameter expansion and top cap release.