In Situ Fenestration With the Electrified Wire Technique-Exploring the Role of Application Duration on Fenestration
Silvia Iodice1,2, George Apostolidis1, Daour Yousef Al Sarhan1
1German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, Germany.
Purpose:
Electrified wire in situ fenestration (EWISF) represents an effective off-the-shelf option in time-sensitive endovascular procedures. This article highlights the importance of radiofrequency energy delivery duration for successful catheter crossing with subsequent ballooning and bridging stent placement.
Case Report:
An 89-year-old man with symptomatic pararenal abdominal aortic aneurysm was transferred to our endovascular center. Given the patient's advanced age and the urgent clinical scenario, an endovascular approach was preferred. Pre-stenting of the stenotic left renal artery (LRA) was followed by intentional coverage of both renal arteries using a tubular aortic endograft with suprarenal fixation (Endurant). The right renal artery was revascularized using a bare metal stent (Visi-Pro) via the parallel technique, whereas the LRA was targeted with EWISF. Intraoperatively, catheter crossing after initial EWISF proved highly challenging. A repeat EWISF procedure with prolonged radiofrequency application was required to accomplish revascularization. Distal extension with a bifurcated endograft, appropriately sized limbs, and subsequent implantation of a physician-modified thoracic endograft, to manage insufficient overlap between the previously implanted endografts, completed the operation.
Conclusion:
Electrified wire in situ fenestration is effective for endograft modification; prolonged energy delivery may be required to achieve catheter passage.Clinical ImpactThe electrified wire technique has emerged as a valuable alternative for in situ fenestration in urgent cases, enabling target vessel revascularization at low cost using readily available equipment. In a patient with a symptomatic pararenal aneurysm undergoing urgent endovascular repair, electrified wire in situ fenestration (EWISF) proved challenging. After intentional coverage of the renal artery ostium with a tubular aortic endograft, the initial EWISF attempt did not allow catheter passage through the endograft. A second attempt with prolonged electrical energy application ultimately enabled successful revascularization of the renal artery. Application duration may affect EWISF success, and acknowledgment of this parameter seems essential for enhanced technique reproducibility.