Novel Surgeon-Modified Fenestrated Iliac Stent Graft.

Jungi, Silvan; Papazoglou, Dimitrios D; Chan, Hon-Lai; Schmidli, Jürg; Makaloski, Vladimir (2023). Novel Surgeon-Modified Fenestrated Iliac Stent Graft. (In Press). Journal of endovascular therapy, p. 15266028231173311. Sage 10.1177/15266028231173311

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PURPOSE

We describe the feasibility and early results of a novel endovascular approach with a surgeon-modified fenestrated iliac stent graft to preserve pelvic perfusion in patients with iliac aneurysms not suitable for iliac branch devices (IBDs).

TECHNIQUE

Seven high-risk patients, median age 76 years (range 63-83), with a complex aortoiliac anatomy with contraindications for commercially available IBDs were treated with a novel surgeon-modified fenestrated iliac stent graft between August 2020 and November 2021. The modified device was built using an iliac limb stent graft (Endurant II Stent Graft; Medtronic), which was partially deployed, surgically fenestrated with a scalpel, reinforced, re-sheathed, and inserted via femoral access. The internal iliac artery was cannulated and bridged with a covered stent. Technical success rate was 100%. After a median follow-up period of 10 months, there was 1 type II endoleak and no migrations, stent fractures, or loss of device integrity. One iliac limb occlusion occurred after 7 months, which needed a secondary endovascular intervention, restoring patency.

CONCLUSION

Surgeon-modified fenestrated iliac stent graft is feasible and might be used as an alternative in patients with a complex iliac anatomy not suitable to commercially available IBDs. Long-term follow-up is needed to evaluate stent graft patency and potential complications.

CLINICAL IMPACT

Surgeon modified fenetrated iliac stent grafts might be a promising alternative to iliac branch devices, extending endovascular solutions to a broader patient population with complex aorto-iliac anatomies preserving antegrade internal iliac artery perfusion. It is possible to treat small iliac bifurcations and large angulations of the iliac bifurcation safely and there is no need for a contralateral or upper-extremity access.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Vascular Surgery
UniBE Contributor:	Jungi, Silvan, Papazoglou, Dimitrios David, Schmidli, Jürg, Makaloski, Vladimir
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1545-1550
Publisher:	Sage
Language:	English
Submitter:	Pubmed Import
Date Deposited:	17 May 2023 08:31
Last Modified:	31 Jul 2024 00:11
Publisher DOI:	10.1177/15266028231173311
PubMed ID:	37191262
Uncontrolled Keywords:	aortoiliac aneurysm endograft endovascular aortic repair fenestration surgeon-modified
URI:	https://boris.unibe.ch/id/eprint/182642