Cannulation of the contralateral gate is a crucial step in endovascular aortic aneurysm repair (EVAR) to configure a modular stent-graft. Most commonly, the contralateral gate is cannulated retrogradely using a conventional catheter and hydrophilic guide wire; if this maneuver fails, a cross-over technique or additional access in the left brachial artery in association with a contralateral femoral snare catheter may be used. A cross-over technique using a microcatheter and a contralateral snare catheter might be a valuable alternative to cannulate the contralateral gate, especially in cases where there is a partly nondeployed contralateral stent-graft limb.
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