Unique Stent-Graft Modification in Emergency High-Risk Patients for Aortic Arch Pathology

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortic Disease Management

Background:

• Aortic arch pathologies present complex endovascular treatment challenges.
• Custom-made devices and hybrid procedures have limitations in availability and invasiveness.
• Physician-modified stent-grafts (PMSGs) are explored as an alternative for urgent interventions.

Purpose of the Study:

• To evaluate the safety and efficacy of a novel PMSG technique for acute aortic syndromes.
• To assess outcomes in high-risk patients requiring urgent aortic arch intervention.
• To determine the feasibility of using patient-specific 3D-printed templates for stent-graft modification.

Main Methods:

• A single-center study of 18 high-risk patients with acute aortic syndromes.
• Modified Medtronic Valiant stent-grafts using sterile 3D-printed templates for fenestration.
• Assessment of technical success, early and mid-term outcomes, neurological complications, endoleaks, and survival.

Main Results:

• 100% technical success with no 30-day mortality.
• Four non-disabling strokes, one access-site bleeding revision, and one transient spinal cord ischemia.
• 83% mid-term survival (median 43 months), with 5 endoleaks; no graft infection or migration.

Conclusions:

• PMSGs are a feasible and effective option for urgent aortic arch repair in high-risk patients.
• The technique allows tailored solutions when standard devices are unavailable, showing high technical success.
• Further multicenter studies are needed to confirm long-term safety and refine techniques for emergency aortic treatment protocols.