Self-made fenestrated modified endograft for urgent an Aortic Arch Aneurysm: Case Report

We report the case of an endovascular repair of an aortic arch aneurysm by a self-made endograft with a single fenestration in a high-risk patient unfit for open surgery. A patient of 81 years, chronic ischemic cardiopathic, suffering from prostate K in chemotherapy treatment, came to our hospital for post-traumatic fracture of the right femur, associated with dysphonia and respiratory disorders for several days. During the hospitalization, the patient performed angio-CT that found the presence of voluminous aneurysm of the aortic arch with a maximum diameter of about 70mm. The patient was treated in the first instance with a carotid-carotid-succlavium bypass to preserve the cerebral and upper limb vascularization. The self-made endograft was created by modifying a standard endograft by a single fenestration following the three-dimensional reconstructions of the CT images. The procedure was completed by implanting this endograft with stent delivery to the patient with a fenestration on the anonymous trunk. The procedure was successfully completed and postoperative course was uneventful. Computed tomography angiography demonstrated the exclusion of the aneurysm, patency of the implanted endograft modules, and absence of signs of endoleaks and / or cerebral or medullary ischemic complications.