Double preloaded internal up-and-over technique for total transfemoral four vessel thoracoabdominal multibranch endoprosthesis with temporary aortic balloon occlusion for ruptured complex abdominal aortic aneurysm.

The thoracoabdominal multibranch endoprosthesis (TAMBE) is the first off-the-shelf, four-vessel branched endograft to obtain US Food and Drug Administration commercial approval for the treatment of complex abdominal and thoracoabdominal aortic aneurysms. Total transfemoral TAMBE approaches, previously described, may benefit patients with challenging aortic arch anatomy. This report presents a further refinement of the internal up-and-over total transfemoral TAMBE technique with temporary aortic balloon occlusion, applied in the setting of a ruptured pararenal abdominal aortic aneurysm.