ArticleJACC. Case reports2025
Intraoperative Physician-Modified Iliac Limb With Fenestration to Rescue a Misplanned FEVAR.
Article in JACC. Case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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5 authors.
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Abstract
backgroundCustom-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.
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