Total Aortic Arch Endograft and Double In Situ Fenestration for Aortobronchial Fistula

This case highlights the challenges of treating an aortobronchial fistula. Emergent total aortic arch stent grafting is limited by inability to maintain cerebral perfusion during in situ fenestration. We describe the application of a new technique to maintain cerebral perfusion using a gutter balloon adjacent to the aortic endograft while great vessel fenestrations are being performed in an urgent setting.