title: Surgeon-modified fenestrated endograft to treat ruptured juxtarenal aneurysm.
abstract: OBJECTIVE
  No endovascular devices are commercially available in the United States to treat high-surgical risk patients with aneurysms extending to visceral arteries. Treatment options are even further limited for symptomatic patients in need of urgent treatment.
  
  
  OBJECTIVE
  To describe a successful urgent endovascular repair of a juxtarenal abdominal aortic aneurysm with contained rupture.
  
  
  METHODS
  A hybrid suite using a surgeon-modified fenestrated endovascular graft and advanced 3-dimensional imaging workstation. The patient was an 82-year-old veteran taking clopidogrel and aspirin for coronary stents with significant cardiopulmonary comorbidities including multiple prior abdominal surgeries and a single functional left kidney.
  
  
  METHODS
  Surgeon-modified fenestrated endovascular aortic aneurysm repair.
  
  
  METHODS
  Clinical, laboratory, and radiographic improvement.
  
  
  RESULTS
  The patient was discharged 5 days after an uneventful postoperative course. On short-term follow-up, the patient had an early return to his baseline functional status. The excluded aneurysm sac shrank with patent visceral branches and there was an absence of endoleak on 3-month and 6-month surveillance computed tomography angiography.
  
  
  CONCLUSIONS
  Surgeon-modified fenestrated stent grafts may be a viable option for selected high-surgical risk patients with symptomatic complex abdominal aortic aneurysms.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: George T
authors.initials: GT
authors.lastname: Pisimisis
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kougias
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Neal R
authors.initials: NR
authors.lastname: Barshes
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Carlos F
authors.initials: CF
authors.lastname: Bechara
mesh_terms: D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging* / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D004630:Emergencies; D057510:Endovascular Procedures / Q000295:instrumentation*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007676:Kidney Failure, Chronic / Q000517:prevention & control; D008297:Male; D010360:Patient Transfer; D011183:Postoperative Complications / Q000517:prevention & control; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging* / Q000601:surgery*; D012086:Reoperation; D014057:Tomography, X-Ray Computed