Intraoperative Physician-Modified Iliac Limb With Fenestration to Rescue a Misplanned FEVAR.
Publisher DOI
PubMed ID
41173613
Abstract
Background
Custom-made fenestrated endografts are an established endovascular treatment for juxtarenal aortic aneurysms. Recently, physician-modified endografts have become more frequently used to accommodate complex anatomies in acute settings.
Case Summary
A 77-year-old man with previous open infrarenal repair with a tube graft developed proximal and distal anastomotic aneurysms, requiring bifurcated fenestrated endovascular aortic aneurysm repair (FEVAR) for aneurysm exclusion. A custom 4-fenestration instead of 5-fenestration FEVAR was planned and manufactured. Intraoperative angiography revealed an additional lower right renal artery. To preserve it, a physician-modified iliac limb with a single fenestration was created intraoperatively. Completion angiography confirmed aneurysm exclusion, proper graft positioning and sealing, and the absence of type I and III endoleaks.
Discussion
This case highlights the importance of physician modification as an adjunctive alternative during complex endovascular procedures.
Take-home Message
Physician-modified endografts can salvage incomplete custom-made FEVAR planning without partially sacrificing kidney function.
Custom-made fenestrated endografts are an established endovascular treatment for juxtarenal aortic aneurysms. Recently, physician-modified endografts have become more frequently used to accommodate complex anatomies in acute settings.
Case Summary
A 77-year-old man with previous open infrarenal repair with a tube graft developed proximal and distal anastomotic aneurysms, requiring bifurcated fenestrated endovascular aortic aneurysm repair (FEVAR) for aneurysm exclusion. A custom 4-fenestration instead of 5-fenestration FEVAR was planned and manufactured. Intraoperative angiography revealed an additional lower right renal artery. To preserve it, a physician-modified iliac limb with a single fenestration was created intraoperatively. Completion angiography confirmed aneurysm exclusion, proper graft positioning and sealing, and the absence of type I and III endoleaks.
Discussion
This case highlights the importance of physician modification as an adjunctive alternative during complex endovascular procedures.
Take-home Message
Physician-modified endografts can salvage incomplete custom-made FEVAR planning without partially sacrificing kidney function.
Date Issued
2025-10-29
Publication Type
Article
Subject(s)
Subjects
FEVAR
•
additional renal artery
•
juxtarenal aortic aneurysm
•
physician-modified aortic endograft
Language(s)
en
Additional Credits
Journal
JACC: Case Reports
Publisher
Elsevier
ISSN
2666-0849
Access(Rights)
open.access