Subclavian Percutaneous Aortic Balloon Occlusion for Abdominal Normothermic Regional Perfusion: Technical Description and Initial Experience

Donation after circulatory death (DCD) is increasingly implemented worldwide and represents a growing source of transplantable organs. Abdominal normothermic regional perfusion (A-NRP), typically performed using a modified venoarterial extracorporeal perfusion circuit, improves outcomes in liver and kidney transplantation but requires reliable exclusion of thoracic, coronary, and cerebral reperfusion. This is commonly achieved by supraceliac aortic occlusion. In donors with severe iliofemoral or aortoiliac disease, femoral access for balloon placement may not be feasible, limiting the applicability of A-NRP. We describe a novel percutaneous subclavian approach for aortic occlusion balloon placement and report limited initial institutional experience in two controlled DCD donors using aggregated procedural feasibility data. This planned alternative route may be considered in selected anatomically challenging cases when standard femoral balloon placement is not feasible.