Double homemade fenestrated stent graft for total endovascular aortic arch repair

Abstract

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Aortic Arch Anatomy Pattern in Patients Treated Using Double Homemade Fenestrated Stent-Grafts for Total Endovascular Aortic Arch Repair

“…It is generally utilized in patients who are otherwise not candidates for open surgery and did not have a proximal landing zone for endovascular treatment, especially in the urgent scenario. [1][2][3][4][5][6] Fenestrations are added to a standard commercial stent-graft to accommodate patient-specific vessel origins, thereby extending the landing zone proximally. Total endovascular arch repair can be achieved without compromise of the blood supply to the upper extremities, head, and neck using these physicianmodified endovascular grafts (PMEGs).…”

“…These stent-grafts have 2 fenestrations: one proximal, large opening for the IA and the LCCA (2 mm larger laterally than the diameters of the IA and LCCA orifices) and 1 distal fenestration for the LSA (Figure 1). Indication, preparation, technique, and results of our doublefenestrated PMEG program have been published in previous reports 4,5 and are summarized in Table 1.…”

Commentary: Chimneys and Physician Stent-Graft Modifications: A Chaotic Process or a Glimpse of the Future?

“…Device fenestration techniques would benefit from better standardization of the technique to pave the way for a broader utilization of physician stent-graft modifications. 6 These endovascular approaches to the aortic arch may appear to be a chaotic process at present, but from this chaos will probably emerge the device of the future.…”

Fenestrated total arch thoracic endovascular aortic repair: coming of age

“…One example is the Najuta semi-custom thoracic fenestrated stent-graft (Kawasumi Laboratories, Tokyo, Japan), which is loaded in a pre-shaped sheath appropriate for the patient's aortic arch anatomy [11]. Another example is the homemade double-fenestrated stent-graft reported by Canaud et al [12]. Deployment of covered stents through the fenestrations in these two devices will not produce local sealing or is not possible because of crossing stent struts; sealing is achieved by apposition of the endograft to the aortic wall, and the technique is thus appropriate only for distal arch or inner curve pathology.…”