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Original Investigation | Association of VA Surgeons

Surgeon-Modified Fenestrated Endograft to Treat Ruptured Juxtarenal Aneurysm

George T. Pisimisis, MD1; Panagiotis Kougias, MD1; Neal R. Barshes, MD1; Carlos F. Bechara, MD1
[+] Author Affiliations
1Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
JAMA Surg. 2014;149(5):447-449. doi:10.1001/jamasurg.2013.4154.
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Published online

Importance  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.

Objective  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.

Intervention  Surgeon-modified fenestrated endovascular aortic aneurysm repair.

Main Outcomes and Measures  Clinical, laboratory, and radiographic improvement.

Results  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.

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Video 1.

Preoperative Imaging Demonstrating Juxtarenal Aortic Aneurysm With Contained Rupture

Video 2.

Preparation and Implantation of Surgeon-Modified Endograft

Surgeon-modified graft preparation with 3-dimensional image reconstruction followed by successful implantation and aneurysm exclusion.

Video 3.

Follow-up Computed Tomography Angiography

Three-month follow-up computed tomography-scan demonstrating patent visceral vessels, exclusion of the aneurysm, and absence of endoleak.

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Web of Science® Times Cited: 1

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