This study states that all the Experience with fenestrated endovascular aneurysm repair (FEVAR) in the treatment of post dissecting aneurysms remains challenging. A 49-year-old man with a history of type A dissection repair (ascending tube graft) presented with a residual 6-cm expanding extent III thoracoabdominal aortic aneurysm. Our objective was to perform a three-vessel FEVAR with a custom-made endograft with preloaded wires for each fenestration. Serial deployment technique was used. This technique allowed us to cannulate each target artery from above while keeping the rest of the fenestrated endograft below each fenestration still in the sheath. By keeping the endograft constrained, space is created outside of the endograft, which is key to facilitate catheter/wire mobility and subsequent target artery cannulation. A custom-made fenestrated endovascular aortic endograft was designed on the basis of measurements obtained from high-resolution computed tomography angiography images on a three-dimensional workstation using standard centerline flow orthogonal techniques (TeraRecon, Foster City, Calif). The graft design included fenestrations to the celiac artery, superior mesenteric artery, and right renal artery. The main body fenestrated graft was designed with a modified preloaded delivery system. We used intravascular ultrasound to confirm true lumen presence and delivered the main body fenestrated graft through the groin using serial deployment technique. Balloon-expandable bridging stent grafts were deployed through the fenestrations to the celiac, superior mesenteric artery, and right renal artery.
Reference link- https://www.jvascsurg.org/article/S0741-5214(20)31442-7/fulltext
