Visceral segment interrupted constraining suture in physician-modified endografts for dissecting thoracoabdominal...

Severe true lumen narrowing in chronic dissecting thoracoabdominal aortic aneurysms (dTAAAs) can compromise accurate fenestration alignment and hinder reliable bridging of the renovisceral branches. We evaluated the safety and feasibility of fenestrated endovascular aortic repair using a physician-modified endograft incorporating a visceral segment interrupted constraining suture. This permanent diameter-constraining modification is intended to stabilize the endograft within a narrowed true lumen and improve target vessel access. Sixteen patients with chronic dTAAA underwent elective repair using a low-profile Zenith Alpha Thoracic device. All 60 renovisceral branches were successfully bridged, resulting in 100% intraoperative technical success, defined as completion of the planned procedure with aneurysm sac sealing, with no 30-day mortality. Three patients required early reintervention for endoleak (1 type IC; 2 type IIIC). Follow-up imaging through 12 months demonstrated durable aneurysm exclusion and sustained branch patency. In this early experience, a visceral segment interrupted constraining suture provided reproducible diameter control and facilitated target vessel access in complex dTAAA treated by physician-modified endograft-based fenestrated endovascular aortic repair.