Bifurcated In-Stent in Situ Technique for Creation of a Bifurcated Bridging Stent-Graft System to 2 Target Vessels Using a Single Directional Branch: A Report of 2 Cases.
Gustavo Paludetto, Lethicia Mesquita, Bruno Pagnin Schmid et al.
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Case in brief
The report describes two patients undergoing complex endovascular aortic aneurysm repair in whom a single directional branch was used to incorporate two target vessels. The bifurcated in-stent in situ technique created a fenestration in the first bridging stent-graft, allowing access to the second vessel; two further stent-grafts formed and reinforced the bifurcation. Neither patient had a reported complication or endoleak, and follow-up computed tomography angiography showed patent branches. The authors describe the technique as a feasible option for incorporating two target vessels through one directional branch.
What made this case unusual
A single directional branch was converted into a bifurcated bridging stent-graft system by creating an in situ fenestration in the first stent-graft and reinforcing the junction with a third stent-graft in a kissing configuration.
Diagnostic / clinical pearl
When anatomy limits standard incorporation of two target vessels, an in situ fenestration in a bridging stent-graft can provide access to a second vessel through one directional branch; this report documents technical feasibility in two patients.
Why it matters
The approach may allow endovascular incorporation of target vessels in challenging anatomy that could otherwise preclude treatment or require intentional artery coverage.