Novel Surgeon-Modified Fenestrated Iliac Stent Graft

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortoiliac Anatomy

Background:

• Iliac aneurysms often present complex anatomies unsuitable for standard iliac branch devices (IBDs).
• Preserving pelvic perfusion is crucial in these high-risk patients.

Purpose of the Study:

• To describe the feasibility and early outcomes of a novel endovascular approach using a surgeon-modified fenestrated iliac stent graft.
• To evaluate its potential to preserve pelvic perfusion in patients with complex iliac aneurysms.

Main Methods:

• Seven high-risk patients with complex aortoiliac anatomy were treated with a custom-modified fenestrated iliac stent graft.
• The device was created by surgically fenestrating an iliac limb stent graft, reinforcing it, and inserting it via femoral access.
• Internal iliac arteries were cannulated and stented to maintain antegrade flow.

Main Results:

• 100% technical success rate was achieved in all seven patients.
• Median follow-up of 10 months showed one type II endoleak, no device migrations, or fractures.
• One iliac limb occlusion occurred but was successfully treated with a secondary intervention.

Conclusions:

• Surgeon-modified fenestrated iliac stent grafts are feasible and may serve as an alternative for complex iliac anatomies where standard IBDs are not suitable.
• This approach can potentially expand endovascular treatment options for a broader patient population, preserving internal iliac artery perfusion.
• Further long-term follow-up is necessary to assess the durability and potential complications of this technique.