Surgeon-modified Fenestrated Thoracic Endovascular Aortic Repair for the Treatment of Aortic Aneurysm

Thoracic endovascular aortic repair( TEVAR) for thoracic aortic aneurysm has been established as a 1st-line therapy, especially in high-risk cases, with device improvements and the appearance of various procedures, but there are still cases of anatomical adaptation. On the other hand, several countermeasures have been developed, but there are no commercially available devices for fenestrated or branched stent grafts in Japan. Moreover, complications such as cerebral infarction, organ ischemia and bypass occlusion and infection are pointed out in popular debranch TEVAR. However the surgeon-modified fenestrated TEVAR can extend the landing zone without open thoracotomy and laparotomy, and can reduce the operation time by decreasing debranch branches. And by the use of a commercially available device, is an urgent correspondence is possible surgical procedures. We report our treatment strategies including experience of 29 cases( Relay Plus:13 cases, Cook TX2:16 cases) of surgeon-modified fenestrated TEVAR that we implemented.