Use of Physician-Modified Fenestrated Stent-Graft With Wire Loop Technique for Complex Aortic Arch Aneurysm.

ABSTRACT Purpose To present a novel means of overcoming a deviation when treating an aortic arch aneurysm with a physician-modified fenestrated stent-graft. Technique A 78-year-old man presented with sharp chest pain. Computed tomography angiography showed a rapidly expanding aortic arch aneurysm, and the limited landing zone required the use of a fenestrated/branched arch endograft. Physician-modified fenestrated stent-grafts are considered suitable for patients in an acute setting. Informed consent was obtained from the patient, and the procedure was approved by the local ethics committee. The device became malrotated in a clockwise direction during deployment; therefore, cannulation of the first inner branch using a through-and-through wire technique was needed. The final angiogram showed a good result. The 3-month computed tomography angiogram showed no endoleak. Conclusion Thoracic endovascular repair of an aortic arch aneurysm using a through-and-through technique can be considered for high-risk patients in an acute setting.