A snare-assisted pull-up technique for side-branch component delivery during thoracic endovascular aortic repair for distal aortic arch aneurysm using Gore Thoracic Branch Endoprosthesis.

We report a case of thoracic endovascular aortic repair using a thoracic branch endoprosthesis for aneurysm enlargement caused by an endoleak after prior fenestrated repair. A 75-year-old man with previous left subclavian artery stenting presented with aneurysm growth. Advancement of the side-branch component through the pre-existing stent was difficult because of severe angulation, and standard push-up techniques failed. A snare-assisted pull-up technique via a pre-existing 6F brachial sheath enabled direct capture and controlled pull-and-push advancement of the device. This method may serve as a simple bailout strategy for difficult branch component delivery.