A technique for increased accuracy in the placement of the "giant" Palmaz stent for treatment of type IA endoleak after endovascular abdominal aneurysm repair.

We report a deployment technique that eliminates "watermelon seeding" of the "giant" Palmaz stent in the treatment of type IA endoleak after endovascular abdominal aneurysm repair. A 5010 Palmaz stent (Cordis Corp, Miami Lakes, Fla) is asymmetrically hand-crimped on an appropriately sized valvuloplasty balloon that assures that the proximal (cranial) aspect will deploy first. A long 16 to 20F sheath is placed distal to the target area. Once the balloon and stent assembly is in position, the sheath is partially retracted to allow only the proximal (cranial) half of the balloon to expand, flaring the unsheathed proximal stent. The expanded proximal balloon prevents cranial stent migration. The sheath prevents distal (caudal) stent migration. Full retraction of the sheath allows the distal balloon and stent to expand, completing the stent deployment.