title: Stent graft modification with mini-cuff reinforced fenestrations for urgent repair of thoracoabdominal aortic aneurysms.
abstract: Fenestrated endografts require 6 to 8 weeks for device customization, and off-the-shelf devices are not yet available and may not be of easy access for urgent repair of complex aneurysms. We describe a technique of stent graft modification in a high-risk male patient with two prior open aortic repairs, end ileostomy, and a rapidly enlarging 10-cm supra-graft type IV thoracoabdominal aortic aneurysm. A Z-stent thoracic stent graft was modified on-site using mini-cuff reinforced fenestrations to incorporate the visceral arteries and improve overlap at the side branch attachment sites. After successful repair, the patient was discharged at 4 days without complications and with patent branched stent grafts without endoleak. On-site modifications of endografts may allow urgent endovascular treatment of complex aortic aneurysms in high-risk patients who are not good candidates for open repair or who do not have access to manufactured fenestrated devices.
authors.affiliation: Division of Vascular & Endovascular Surgery, Mayo Clinic, Rochester, MN 55905, USA. oderich.gustavo@mayo.edu
authors.forename: Gustavo S
authors.initials: GS
authors.lastname: Oderich
authors.forename: Javairiah
authors.initials: J
authors.lastname: Fatima
authors.forename: Peter
authors.initials: P
authors.lastname: Gloviczki
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000295:instrumentation*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome