Endovascular innovation in a hostile abdomen: Repairing aortic rupture with a physician-modified endograft

Emergent endovascular aneurysm repair is challenging in cases with unfavorable anatomy. We describe a patient with prior small bowel transplants dependent on a hypertrophic inferior mesenteric artery and a right common iliac to superior mesenteric artery bypass presenting with contained infrarenal aortic rupture. Emergent repair used two physician-modified endografts: a Gore Excluder C3 with a fenestration for the inferior mesenteric artery and an excluder limb with a single fenestration for the iliac to superior mesenteric artery bypass. Both fenestrations were stented, with postoperative imaging confirming patency. This case highlights the adaptability of physician-modified endografts, emphasizing the value of individualized device planning.