Technical Approach to Rescuing a Previous Physician-Modified Endovascular Graft with a New Physician-Modified Endovascular Graft.
Emiel W M Huistra, Samuel Saers, Talje M Fokkema et al.
✦ AI-curated · Sources linked
Case in brief
A 77-year-old man with an infectious native aortic aneurysm underwent repair with a physician-modified endovascular graft (PMEG) fenestrated for the renal arteries and superior mesenteric artery. A subsequent infectious aneurysm at the right renal hilum was managed by occluding the right renal artery with a vascular plug. Later imaging showed a suspected new aneurysm near the celiac trunk, just proximal to the original graft. A second PMEG, fenestrated for the left renal artery and superior mesenteric artery, was deployed within the first graft and extended proximally with a thoracic stent graft. Angiography and one-month CT angiography showed successful aneurysm exclusion.
What made this case unusual
The repair required relining and proximally extending a prior fenestrated PMEG to treat a new suspected infectious aneurysm immediately proximal to it.
Diagnostic / clinical pearl
When planning a PMEG, consider how a future proximal extension could be accommodated; this case used a second fenestrated PMEG within the original graft for urgent reintervention.