Minimizing the landing zone of complex aortic repair using a physician-modified endograft to preserve a prominent Adamkiewicz artery

Abstract

AbstractThere are increasing number of clinical cases with physician-modified endograft (PMEG) endograft for urgent reconstruction of large pararenal aneurysms to reduce the perioperative complication risks of fragile patients, but the risk of spinal cord ischemia due to the coverage of longer segment of thoracic aorta is relatively high.We demonstrate an expedited endovascular treatment of an 88 mm pararenal aneurysm by performing a 4-vessel fenestrated endovascular aortic repair. A prominent Adamkiewicz artery, ectatic supraceliac aortic segment, median arcuate ligament compression of the celiac artery and severe tortuosity of the common iliac arteries made the endovascular repair more challenging. A PMEG was implanted with simultaneous deployment technique to achieve a short proximal landing zone to preserve the Adamkiewicz artery.The proper risk assessment and preparation of the patient based on the clinical evaluation and procedure planning is essential for the clinical success of PMEG in urgent indication.