Technical Approach to Rescuing a Previous Physician-Modified Endovascular Graft with a New Physician-Modified Endovascular Graft

Abstract

Purpose:

To demonstrate the feasibility of the physician-modified endovascular graft (PMEG) technique in acute aorta disease, even in cases with a previous PMEG requiring a new repair.

Technique:

A 77-year-old man presented with an infectious native aortic aneurysm (INAA), which was treated with a PMEG containing fenestrations for the renal arteries and superior mesenteric artery (SMA). After 4 months, a new infectious aneurysm developed at the right renal hilum, which was treated by occluding the right renal artery with a vascular plug. At the 1-year follow-up, computerized tomography angiography (CTA) demonstrated a new suspected INAA at the level of the celiac trunk, just proximal to the previous PMEG. A new PMEG with fenestrations for the left renal artery and SMA was deployed within the previous PMEG, followed by a proximal extension of the PMEG with a thoracic stent graft. Completion angiography and CTA follow-up at 1 month showed successful exclusion of the aneurysm.

Conclusion:

Treatment with a PMEG may provide an endovascular solution for patients requiring urgent aneurysm repair even after a previous PMEG. This case also highlights the importance of anticipating a future proximal extension when planning a PMEG

Clinical Impact

This article demonstrates the use of a physician-modified endovascular graft (PMEG) to reline and proximally extend a previously implanted PMEG requiring urgent repair. Although technically challenging, this approach provides a safe and effective endovascular solution for patients with a previous fenestrated endograft requiring urgent repair, thereby avoiding the need for open surgery. This case underscores the benefit of PMEGs to the vascular surgeon’s armamentarium and emphasizes the importance of anticipating future reinterventions during primary procedures