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.
To describe a successful urgent endovascular repair of a juxtarenal abdominal aortic aneurysm with contained rupture.
Design, Setting, and Participants
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.
Surgeon-modified fenestrated endovascular aortic aneurysm repair.
Main Outcomes and Measures
Clinical, laboratory, and radiographic improvement.
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 and Relevance
Surgeon-modified fenestrated stent grafts may be a viable option for selected high–surgical risk patients with symptomatic complex abdominal aortic aneurysms.