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Physician-modified fenestrated Navion endograft for the treatment of a symptomatic postdissection thoracoabdominal aneurysm

We report the case of a physician-modified four-fenestration endograft for the emergent treatment of a 65-year-old patient with postdissection thoracoabdominal aneurysm deemed unfit for open surgery. The patient, after elective thoracic endovascular aneurysm repair as the first stage of a preplanned...

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Autores principales: Gibello, Lorenzo, Frola, Edoardo, Ripepi, Matteo, Ruffino, Maria Antonella, Varetto, Gianfranco, Verzini, Fabio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8143976/
https://www.ncbi.nlm.nih.gov/pubmed/34041426
http://dx.doi.org/10.1016/j.jvscit.2021.03.011
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author Gibello, Lorenzo
Frola, Edoardo
Ripepi, Matteo
Ruffino, Maria Antonella
Varetto, Gianfranco
Verzini, Fabio
author_facet Gibello, Lorenzo
Frola, Edoardo
Ripepi, Matteo
Ruffino, Maria Antonella
Varetto, Gianfranco
Verzini, Fabio
author_sort Gibello, Lorenzo
collection PubMed
description We report the case of a physician-modified four-fenestration endograft for the emergent treatment of a 65-year-old patient with postdissection thoracoabdominal aneurysm deemed unfit for open surgery. The patient, after elective thoracic endovascular aneurysm repair as the first stage of a preplanned two-stage total thoracoabdominal endovascular repair, presented acute onset of dyspnea and thoracic pain. Computed tomography angiography (CTA) showed signs of contained rupture. The Valiant Navion thoracic endograft was used for the creation of a physician-modified four-fenestration stent graft. A diameter-reducing wire technique was used to constrain posteriorly the prosthetic graft and to allow intraprocedural partial deployment. The modified stent graft was finally folded into its original sheath and implanted; four balloon-expandable stent grafts were used as bridging components. Postoperative CTA showed a residual type IIIc endoleak that was treated with a relining procedure 4 months later. At the 20-month follow-up, the patient is alive and well and CTA shows complete seal of the thoracic aneurysm with persisting small type IIIc endoleak in the abdominal aneurysm. A physician-modified endograft can be considered a valuable option in case of urgent treatment of TAAA in patients deemed unfit for open surgery when off-the-shelf devices are not available or contraindicated.
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spelling pubmed-81439762021-05-25 Physician-modified fenestrated Navion endograft for the treatment of a symptomatic postdissection thoracoabdominal aneurysm Gibello, Lorenzo Frola, Edoardo Ripepi, Matteo Ruffino, Maria Antonella Varetto, Gianfranco Verzini, Fabio J Vasc Surg Cases Innov Tech Innovative technique We report the case of a physician-modified four-fenestration endograft for the emergent treatment of a 65-year-old patient with postdissection thoracoabdominal aneurysm deemed unfit for open surgery. The patient, after elective thoracic endovascular aneurysm repair as the first stage of a preplanned two-stage total thoracoabdominal endovascular repair, presented acute onset of dyspnea and thoracic pain. Computed tomography angiography (CTA) showed signs of contained rupture. The Valiant Navion thoracic endograft was used for the creation of a physician-modified four-fenestration stent graft. A diameter-reducing wire technique was used to constrain posteriorly the prosthetic graft and to allow intraprocedural partial deployment. The modified stent graft was finally folded into its original sheath and implanted; four balloon-expandable stent grafts were used as bridging components. Postoperative CTA showed a residual type IIIc endoleak that was treated with a relining procedure 4 months later. At the 20-month follow-up, the patient is alive and well and CTA shows complete seal of the thoracic aneurysm with persisting small type IIIc endoleak in the abdominal aneurysm. A physician-modified endograft can be considered a valuable option in case of urgent treatment of TAAA in patients deemed unfit for open surgery when off-the-shelf devices are not available or contraindicated. Elsevier 2021-04-15 /pmc/articles/PMC8143976/ /pubmed/34041426 http://dx.doi.org/10.1016/j.jvscit.2021.03.011 Text en © 2021 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Innovative technique
Gibello, Lorenzo
Frola, Edoardo
Ripepi, Matteo
Ruffino, Maria Antonella
Varetto, Gianfranco
Verzini, Fabio
Physician-modified fenestrated Navion endograft for the treatment of a symptomatic postdissection thoracoabdominal aneurysm
title Physician-modified fenestrated Navion endograft for the treatment of a symptomatic postdissection thoracoabdominal aneurysm
title_full Physician-modified fenestrated Navion endograft for the treatment of a symptomatic postdissection thoracoabdominal aneurysm
title_fullStr Physician-modified fenestrated Navion endograft for the treatment of a symptomatic postdissection thoracoabdominal aneurysm
title_full_unstemmed Physician-modified fenestrated Navion endograft for the treatment of a symptomatic postdissection thoracoabdominal aneurysm
title_short Physician-modified fenestrated Navion endograft for the treatment of a symptomatic postdissection thoracoabdominal aneurysm
title_sort physician-modified fenestrated navion endograft for the treatment of a symptomatic postdissection thoracoabdominal aneurysm
topic Innovative technique
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8143976/
https://www.ncbi.nlm.nih.gov/pubmed/34041426
http://dx.doi.org/10.1016/j.jvscit.2021.03.011
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