Physician-Modified Endografts Inner Branches Technique Using a Thoracic Endograft for Urgent Thoracoabdominal Aneurysm Repair

Abstract

Purpose:

To describe a standardized technique for modifying a Valiant Captivia endograft using pre-cannulated inner branches (PCIBs) for the treatment of thoracoabdominal aortic aneurysms. This approach offers a practical solution in urgent cases where custom-made devices are unavailable.

Technique:

A Valiant Captivia endograft is modified by creating fenestrations using an ophthalmic cautery and preparing PCIBs with 7 mm Solaris stents for the visceral arteries. The graft is carefully planned to fit the delivery sheath, ensuring that inner branches can be accommodated. The stents are secured with 4.0 Ethibond sutures and marked with radiopaque coils for enhanced visibility. Guidewires (0.035″ for the superior mesenteric artery or celiac trunk, and 0.014″ or 0.018″ for the renal arteries) are prepositioned to facilitate vessel cannulation. Key steps, such as precise device selection, first bare stent stability, and sequential Rummel tourniquets placement, are employed to optimize re-sheathing and deployment.

Conclusion:

The Valiant inner-branch technique is highly reproducible, and physician-modified endograft techniques with PCIBs are a valuable tool for urgent thoracoabdominal aortic aneurysm repair.

Clinical Impact

This standardized technique for modifying the Valiant Captivia endograft with precannulated inner branches provides a reproducible solution for urgent thoracoabdominal aneurysm repair, representing an effective alternative when custom-made devices are unavailable.