Related Experiment Video
Updated: May 1, 2026
Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm
Published on: August 1, 2025
Surgeon-modified fenestrated endograft to treat ruptured juxtarenal aneurysm
George T Pisimisis1, Panagiotis Kougias1, Neal R Barshes1
1Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
Importance:
No endovascular devices are commercially available in the United States to treat high-surgical risk patients with aneurysms extending to visceral arteries. Treatment options are even further limited for symptomatic patients in need of urgent treatment.
Objective:
To describe a successful urgent endovascular repair of a juxtarenal abdominal aortic aneurysm with contained rupture.
Design, Setting, And Participants:
A hybrid suite using a surgeon-modified fenestrated endovascular graft and advanced 3-dimensional imaging workstation. The patient was an 82-year-old veteran taking clopidogrel and aspirin for coronary stents with significant cardiopulmonary comorbidities including multiple prior abdominal surgeries and a single functional left kidney.
Intervention:
Surgeon-modified fenestrated endovascular aortic aneurysm repair.
Main Outcomes And Measures:
Clinical, laboratory, and radiographic improvement.
Results:
The patient was discharged 5 days after an uneventful postoperative course. On short-term follow-up, the patient had an early return to his baseline functional status. The excluded aneurysm sac shrank with patent visceral branches and there was an absence of endoleak on 3-month and 6-month surveillance computed tomography angiography.
Conclusions And Relevance:
Surgeon-modified fenestrated stent grafts may be a viable option for selected high-surgical risk patients with symptomatic complex abdominal aortic aneurysms.
