Surgeon-modified fenestrated endograft to treat ruptured juxtarenal aneurysm.

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.