title: In situ stent-graft fenestration to preserve the left subclavian artery.
abstract: OBJECTIVE
  To report our first clinical application of a new technique for in situ fenestration of a thoracic stent-graft.
  
  
  METHODS
  After completing a series of in vitro and in vivo experiments, in situ stent-graft fenestration was employed during endograft repair of a saccular thoracic aortic aneurysm in a 77-year-old woman. Because the stent-graft would have covered the left subclavian artery ostium, a modified Zenith TX1 thoracic stent-graft was deployed then fenestrated transluminally using a guidewire followed by serial cutting balloons, which created a fenestration over the LSA sufficiently large to accommodate a Jomed covered stent on an 8-mm balloon. Completion angiography showed exclusion of the aneurysm and brisk flow into the LSA. Following the procedure, the arm pressures were nearly equal. The 6-month CT scan showed no endoleak and a patent subclavian artery stent.
  
  
  CONCLUSIONS
  In situ graft fenestration to preserve the left subclavian artery after deliberate coverage during endovascular repair of a thoracic aortic aneurysm appears feasible in this initial clinical application. There are uncertainties regarding the long-term stability of the fabric tears that are an inherent part of this technique.
authors.affiliation: Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK. richard@mcwilliams.u-net.com
authors.forename: Richard G
authors.initials: RG
authors.lastname: McWilliams
authors.forename: Micheal
authors.initials: M
authors.lastname: Murphy
authors.forename: David
authors.initials: D
authors.lastname: Hartley
authors.forename: Michael M D
authors.initials: MM
authors.lastname: Lawrence-Brown
authors.forename: Peter L
authors.initials: PL
authors.lastname: Harris
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D006801:Humans; D011474:Prosthesis Design; D015607:Stents; D013348:Subclavian Artery