Physician-Modified Custom Made Endograft Adding an Outer Branch to Correct a Fenestration Offset.
Lorenzo Torri, Petroula Nana, José I Torrealba et al.
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Case in brief
An 80-year-old man with a symptomatic 80 mm juxtarenal aneurysm required urgent repair. A fenestrated custom-made endograft available for another patient was used; three of its four fenestrations aligned with the intended target vessels, but the left renal artery fenestration lay 15 mm below the artery’s origin. A 6 mm covered stent was sutured to that fenestration to form a retrograde outer branch. The procedure was successful, and the postoperative course was uneventful. Predischarge computed tomography showed a patent target vessel and no endoleak.
What made this case unusual
The device’s left renal artery fenestration was substantially offset from the vessel origin; the team addressed this by suturing a covered stent to the fenestration to create a retrograde outer branch.
Diagnostic / clinical pearl
When an available fenestrated device does not align with a target vessel, this case describes adding an outer branch to accommodate the offset; imaging confirmed target-vessel patency and no endoleak.
Why it matters
The report illustrates a possible modification of an available custom-made device for urgent repair when its fenestration does not match the patient’s anatomy.