title: In situ fenestration in the aortic arch.
abstract: In situ fenestration of aortic stent grafts has the potential to allow for continued perfusion of supra-aortic trunks, without the need for extra-anatomic bypass, and without the need for custom-made devices. Angulation of the target vessel relative to the arch is an obstacle to success with this technique. In this report, we describe a case of successful in situ fenestration of the left subclavian artery (LSA) in a patient with an aortic arch aneurysm, treated with an endovascular stent graft. We outline a novel technique using through and through wire access and a pre-curved semi-rigid sheath, which allows successful access to the lumen of the aortic stent graft, despite an acute angle at the take-off of the LSA.
authors.affiliation: University College London and University College London Hospital, 235 Euston Road, London NW1 2BU, England. brianjmanning@gmail.com
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Manning
authors.forename: Krassi
authors.initials: K
authors.lastname: Ivancev
authors.forename: Peter L
authors.initials: PL
authors.lastname: Harris
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D011474:Prosthesis Design; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome