Physician-Modified Custom Made Endograft Adding an Outer Branch to Correct a Fenestration Offset.

Area of Science:

• Vascular Surgery
• Endovascular Aneurysm Repair
• Aortic Aneurysm Management

Background:

• Juxtarenal aortic aneurysms present complex endovascular repair challenges.
• Custom-made devices (CMDs) offer tailored solutions but require significant lead time.
• Urgent cases may necessitate rapid adaptation of available endovascular devices.

Purpose of the Study:

• To describe a novel physician-modified endograft (PMEG) technique.
• To incorporate an outer branch into a pre-existing fenestrated CMD for urgent juxtarenal aneurysm repair.
• To manage a complex aortic anatomy when a standard device was not immediately available.

Main Methods:

• An 80-year-old male with an 80 mm juxtarenal aneurysm underwent urgent repair.
• A fenestrated CMD intended for another patient was utilized.
• A retrograde outer branch was created by suturing a covered stent to a misaligned fenestration.

Main Results:

• The PMEG procedure was technically successful.
• The postoperative course was uneventful.
• Predischarge imaging confirmed target vessel patency and absence of endoleak.

Conclusions:

• Physician modification of CMDs, including adding outer branches, is feasible for urgent complex aortic aneurysm repair.
• Utilizing available CMDs reduces preparation time and complexity in emergent scenarios.
• This technique expands the applicability of fenestrated stent grafts in situations lacking off-the-shelf options.