title: Physician-Modified C3 Excluder Endograft as the Preferred Solution to Treat a Juxtarenal Para-Anastomotic Aneurysm.
abstract: Feasibility and early satisfactory results of physician-modified endografts have been reported. Most reports described the use of Cook Dacron aortic endografts (Cook Medical, Inc., Bloomington, IN). However, in some specific anatomic features (short aortic length, narrow aorta), the use of this device may not be appropriate.We here report a case of juxtarenal aortic aneurysm proximal to a former aortobifemoral graft in a high surgical risk patient. Due to a narrow proximal neck and a short aortic length, a physician-modified Gore C3 Excluder device (W. L. Gore & Associates, Inc., Flagstaff, AR) incorporating a fenestration for a large accessory renal artery was implanted. At 6-month follow-up, the aneurysm remains excluded and computed tomography scan demonstrates patent renal vessels.Surgeon-modified Gore C3 Excluder device implantation is feasible. Because of specific device characteristics (short main body, repositioning ability), it represents a valuable alternative in high-risk patients with juxtarenal aneurysms not amenable to other techniques.
authors.affiliation: Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris, Boulogne-Billancourt, France; Faculté de Médecine Paris-Ile-de-France Ouest, UFR des sciences de la santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: Couture
authors.affiliation: Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris, Boulogne-Billancourt, France; Faculté de Médecine Paris-Ile-de-France Ouest, UFR des sciences de la santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France; UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paul Brousse Hospital, Villejuif, France. Electronic address: rcoscas@gmail.com.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Coscas
authors.affiliation: Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris, Boulogne-Billancourt, France; Faculté de Médecine Paris-Ile-de-France Ouest, UFR des sciences de la santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France.
authors.forename: Henri
authors.initials: H
authors.lastname: Lamas
authors.affiliation: Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris, Boulogne-Billancourt, France; Faculté de Médecine Paris-Ile-de-France Ouest, UFR des sciences de la santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France.
authors.forename: Amélie
authors.initials: A
authors.lastname: Mlynski
authors.affiliation: Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris, Boulogne-Billancourt, France; Faculté de Médecine Paris-Ile-de-France Ouest, UFR des sciences de la santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Javerliat
authors.affiliation: Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris, Boulogne-Billancourt, France; Faculté de Médecine Paris-Ile-de-France Ouest, UFR des sciences de la santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France; UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paul Brousse Hospital, Villejuif, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Goeau-Brissonniere
authors.affiliation: Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris, Boulogne-Billancourt, France; Faculté de Médecine Paris-Ile-de-France Ouest, UFR des sciences de la santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Coggia
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation*; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000295:instrumentation*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012077:Renal Artery / Q000002:abnormalities / Q000601:surgery; D012086:Reoperation; D016896:Treatment Outcome