Physician modification of a thoracoabdominal branch endoprosthesis into a shortened unibody branched device

A short distance between the lowest renal artery and the flow divider after previous endovascular aortic repair presents a significant technical challenge, often necessitating open conversion. The GORE Thoracoabdominal Branch Endoprosthesis (W. L. Gore & Associates) offers an off-the-shelf endovascular solution for these patients; however, its fixed length results in extensive supraceliac coverage, increasing the risk of spinal cord ischemia. In addition, in smaller paravisceral aortas branch crowding may compromise visceral stent patency. We present a case of physician modification of the Thoracoabdominal Branch Endoprosthesis device into a shortened unibody bifurcated configuration by removing and reconstructing the distal aspect of the device. This technique may expand endovascular options for patients with limited infrarenal working length to the flow divider of a previous endovascular aortic repair while mitigating risks associated with standard device configurations.