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Modified fenestrated stent grafts: device design, modifications, implantation, and current applications
Gustavo S Oderich1, Joseph J Ricotta
1Division of Vascular and Endovascular Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. oderich.gustavo@mayo.edu
Perspectives in Vascular Surgery and Endovascular Therapy
|December 8, 2009
Summary
Modified fenestrated stent grafts offer a solution for complex aortic aneurysms when standard grafts fail. These customized devices enable endovascular repair for visceral and renal artery involvement, expanding treatment options for high-risk patients.
Area of Science:
- Vascular Surgery
- Endovascular Repair
- Aortic Aneurysm Treatment
Background:
- Standard infrarenal stent grafts are unsuitable for aneurysms involving renal, visceral, or hypogastric arteries.
- Short or angulated graft necks also preclude standard endovascular treatment.
Purpose of the Study:
- To describe the design, modification, and implantation techniques for fenestrated stent grafts.
- To highlight the role of modified fenestrated stent grafts in treating complex aortic aneurysms.
Main Methods:
- Customization of fenestrated stent grafts with reinforced fenestrations to incorporate visceral and renal arteries.
- Selective use in patients with large aortoiliac, juxtarenal, pararenal, or thoracoabdominal aortic aneurysms.
- Summarizing principles of device design, procedure planning, and implantation technique.
Main Results:
- Fenestrated stent grafts allow for adequate proximal sealing zones in complex aortic anatomy.
- Modified fenestrated stent grafts provide an option for patients ineligible for standard endovascular repair.
- These devices are not yet commercially available in the US, necessitating modification for compassionate use.
Conclusions:
- Modified fenestrated stent grafts are valuable for treating complex aortic aneurysms in selected high-risk patients.
- They offer a crucial alternative for urgent or emergent repairs when standard devices are not feasible.
- Further application in compassionate use and urgent cases is anticipated.