In Situ Fenestration for Branch Vessel Preservation during EVAR

Introduction

Unfavorable proximal aortic neck anatomy poses a formidable challenge to the successful repair of endovascular aortic aneurysms.^{1, 2} Currently, there are no commercially available devices in the United States for the endovascular management of pararenal or juxtarenal aneurysms, or even aneurysms with short (i.e., <10 mm) infrarenal necks. We report a successful and totally percutaneous endovascular aneurysm repair of a juxtarenal abdominal aortic aneurysm with preservation of renal artery perfusion using in-situ fenestration of a repositionable commercially available device. The procedure was uncomplicated, and the patient returned to normal activities. At 1-month follow-up there was no evidence of endoleak, no migration or stent occlusion, and patent bilateral renal arteries. This innovative technique is attractive for patients with suitable anatomy and offers another approach to the ever-growing alternatives for dealing with a hostile proximal aortic neck during EVAR.