title: Early Results of Physician Modified Fenestrated Stent Grafts for the Treatment of Thoraco-abdominal Aortic Aneurysms.
abstract: OBJECTIVE
  The aim was to determine whether physician modified stent grafts (PMSGs) are safe and effective for the treatment of high risk patients with thoraco-abdominal aortic aneurysms (TAAAs).
  
  
  METHODS
  This was a retrospective single institution study.
  
  
  METHODS
  Consecutive patients with TAAA undergoing endovascular repair using a PMSG between January 2012 and June 2014 were evaluated.
  
  
  METHODS
  Fenestrations to preserve branch vessels were created in TX2 thoracic (Cook Medical) stent grafts. Pre- intra- and post-operative data were recorded by means of a prospectively maintained database.
  
  
  RESULTS
  Eleven high risk patients with TAAA (type I, n = 4; type III, n = 3; type IV, n = 3; type V, n = 1) underwent fenestrated endovascular repair using PMSGs. Indications were painful aneurysm (n = 5), >70 mm rapidly enlarging aneurysm (n = 4), saccular aneurysm (n = 1), and visceral patch false aneurysm after open repair of a type IV TAAA (n = 1). In four asymptomatic patients, an additional fenestration was created for temporary selective sac perfusion and occluded 2-4 weeks later. Median duration for stent graft modifications was 2 hours (range 1-3 hours). The median number of fenestrations was three (range 2-4). One patient died during the post-operative period from colonic ischemia, giving a 9% in hospital mortality rate. Four (36%) patients presented with moderate to severe complications. One (9%) patient presented with a paraparesis that resolved completely after spinal fluid drainage. Among surviving patients, four required early endovascular re-intervention for type III endoleak (n = 2), type Ia endoleak (n = 1), or target vessel cannulation failure (n = 1). The median follow up time was 6 months (range 3-20 months). During follow up, no other complications occurred and all target vessels remained patent. One patient presented with a persistent type II endoleak.
  
  
  CONCLUSIONS
  PMSGs provided acceptable short-term results and may be a management option for the treatment of TAAA in selected high risk patients. Durability concerns need to be assessed in additional studies with long-term follow up.
authors.affiliation: Department of Vascular Surgery, Henri Mondor Hospital, Créteil, France. Electronic address: cochennecf@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Cochennec
authors.affiliation: Department of Radiology and Medical Imaging, Henri Mondor Hospital, Créteil, France.
authors.forename: H
authors.initials: H
authors.lastname: Kobeiter
authors.affiliation: Department of Vascular Surgery Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, UK.
authors.forename: M
authors.initials: M
authors.lastname: Gohel
authors.affiliation: Department of Vascular Surgery, Henri Mondor Hospital, Créteil, France.
authors.forename: M
authors.initials: M
authors.lastname: Leopardi
authors.affiliation: Department of Vascular Surgery, Henri Mondor Hospital, Créteil, France.
authors.forename: M
authors.initials: M
authors.lastname: Raux
authors.affiliation: Department of Vascular Surgery, Henri Mondor Hospital, Créteil, France.
authors.forename: M
authors.initials: M
authors.lastname: Majewski
authors.affiliation: Department of Vascular Surgery, Henri Mondor Hospital, Créteil, France.
authors.forename: P
authors.initials: P
authors.lastname: Desgranges
authors.affiliation: Department of Vascular Surgery, Henri Mondor Hospital, Créteil, France.
authors.forename: E
authors.initials: E
authors.lastname: Allaire
authors.affiliation: Department of Vascular Surgery, Henri Mondor Hospital, Créteil, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Becquemin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: Branched stent grafting; Endovascular repair of aortic aneurysm; Fenestrated stent grafting; Thoraco-abdominal aortic aneurysm