Surgeon-modified fenestrated endograft to treat ruptured juxtarenal aneurysm

IMPORTANCE No endovascular devices are commercially available in the United States to treat high-surgical risk patients with aneurysms extending to visceral arteries. Treatment options are even further limited for symptomatic patients in need of urgent treatment. OBJECTIVE To describe a successful urgent endovascular repair of a juxtarenal abdominal aortic aneurysm with contained rupture. DESIGN, SETTING, AND PARTICIPANTS A hybrid suite using a surgeon-modified fenestrated endovascular graft and advanced 3-dimensional imaging workstation. The patient was an 82-year-old veteran taking clopidogrel and aspirin for coronary stents with significant cardiopulmonary comorbidities including multiple prior abdominal surgeries and a single functional left kidney. INTERVENTION Surgeon-modified fenestrated endovascular aortic aneurysm repair. MAIN OUTCOMES AND MEASURES Clinical, laboratory, and radiographic improvement. RESULTS The patient was discharged 5 days after an uneventful postoperative course. On short-term follow-up, the patient had an early return to his baseline functional status. The excluded aneurysm sac shrank with patent visceral branches and there was an absence of endoleak on 3-month and 6-month surveillance computed tomography angiography. CONCLUSIONS AND RELEVANCE Surgeon-modified fenestrated stent grafts may be a viable option for selected high-surgical risk patients with symptomatic complex abdominal aortic aneurysms.