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Integration of a Custom-Made Fenestration to Simplify Acute Reno-Visceral In Situ Aortic Repair

Berczeli, Marton LU orcid ; Sonesson, Björn LU ; Karelis, Angelos LU orcid ; Oderich, Gustavo S. and Dias, Nuno V. LU orcid (2023) In Journal of Endovascular Therapy
Abstract

Purpose: To illustrate the technique of antegrade in situ laser fenestration (ISLF) on a predesign custom-manufactured stent-graft with single reinforced fenestration for use in emergency endovascular repair of complex abdominal aortic aneurysms (AAAs). Technique: A short custom-made device (CMD) fenestrated graft was predesigned with a single preloaded 8 mm strut-free fenestration at 12 o’clock position. A modified preloaded system was used to allow unilateral access from the distal port if necessary. After bilateral percutaneous femoral access, the graft was deployed under fusion guidance with the CMD fenestration matching the superior mesenteric artery (SMA) origin and immediately bridged as per standard technique. The aneurysm was... (More)

Purpose: To illustrate the technique of antegrade in situ laser fenestration (ISLF) on a predesign custom-manufactured stent-graft with single reinforced fenestration for use in emergency endovascular repair of complex abdominal aortic aneurysms (AAAs). Technique: A short custom-made device (CMD) fenestrated graft was predesigned with a single preloaded 8 mm strut-free fenestration at 12 o’clock position. A modified preloaded system was used to allow unilateral access from the distal port if necessary. After bilateral percutaneous femoral access, the graft was deployed under fusion guidance with the CMD fenestration matching the superior mesenteric artery (SMA) origin and immediately bridged as per standard technique. The aneurysm was then excluded with a bifurcated device. A large steerable sheath was used to allow for sequential antegrade laser in situ fenestration and stenting of the renal arteries. Conclusions: Single-vessel customized short fenestrated grafts for the SMA and antegrade in situ laser renal fenestrations are technically feasible for repair of acute complex AAAs even after previous infrarenal reconstruction. It could become an off-the-shelf solution to limit aortic coverage and reno-visceral ischemia, even in patients with a narrow aortic diameter at the renal level. Clinical Impact: Single-vessel precustomized short fenestrated grafts for the SMA combined with renal artery antegrade ISLF can be a feasible option for the acute repair of patients with complex aneurysms and a narrow aortic diameter at the reno-visceral segment. It may limit aortic coverage and reno-visceral ischemic time and also be applicable after previous infrarenal endovascular aneurysm repair (EVAR).

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
acute aortic treatment, antegrade laser fenestration, endovascular aortic repair, in situ laser fenestration, juxtarenal aortic aneurysm, pararenal aortic aneurysm, ruptured aortic aneurysm
in
Journal of Endovascular Therapy
publisher
International Society of Endovascular Specialists
external identifiers
  • pmid:37902446
  • scopus:85175437448
ISSN
1526-6028
DOI
10.1177/15266028231208656
language
English
LU publication?
yes
id
fc876144-4958-40be-bd07-868b2bc09a51
date added to LUP
2023-11-24 14:51:17
date last changed
2024-04-21 17:40:29
@article{fc876144-4958-40be-bd07-868b2bc09a51,
  abstract     = {{<p>Purpose: To illustrate the technique of antegrade in situ laser fenestration (ISLF) on a predesign custom-manufactured stent-graft with single reinforced fenestration for use in emergency endovascular repair of complex abdominal aortic aneurysms (AAAs). Technique: A short custom-made device (CMD) fenestrated graft was predesigned with a single preloaded 8 mm strut-free fenestration at 12 o’clock position. A modified preloaded system was used to allow unilateral access from the distal port if necessary. After bilateral percutaneous femoral access, the graft was deployed under fusion guidance with the CMD fenestration matching the superior mesenteric artery (SMA) origin and immediately bridged as per standard technique. The aneurysm was then excluded with a bifurcated device. A large steerable sheath was used to allow for sequential antegrade laser in situ fenestration and stenting of the renal arteries. Conclusions: Single-vessel customized short fenestrated grafts for the SMA and antegrade in situ laser renal fenestrations are technically feasible for repair of acute complex AAAs even after previous infrarenal reconstruction. It could become an off-the-shelf solution to limit aortic coverage and reno-visceral ischemia, even in patients with a narrow aortic diameter at the renal level. Clinical Impact: Single-vessel precustomized short fenestrated grafts for the SMA combined with renal artery antegrade ISLF can be a feasible option for the acute repair of patients with complex aneurysms and a narrow aortic diameter at the reno-visceral segment. It may limit aortic coverage and reno-visceral ischemic time and also be applicable after previous infrarenal endovascular aneurysm repair (EVAR).</p>}},
  author       = {{Berczeli, Marton and Sonesson, Björn and Karelis, Angelos and Oderich, Gustavo S. and Dias, Nuno V.}},
  issn         = {{1526-6028}},
  keywords     = {{acute aortic treatment; antegrade laser fenestration; endovascular aortic repair; in situ laser fenestration; juxtarenal aortic aneurysm; pararenal aortic aneurysm; ruptured aortic aneurysm}},
  language     = {{eng}},
  publisher    = {{International Society of Endovascular Specialists}},
  series       = {{Journal of Endovascular Therapy}},
  title        = {{Integration of a Custom-Made Fenestration to Simplify Acute Reno-Visceral In Situ Aortic Repair}},
  url          = {{http://dx.doi.org/10.1177/15266028231208656}},
  doi          = {{10.1177/15266028231208656}},
  year         = {{2023}},
}