Urgent endovascular treatment of symptomatic or contained ruptured aneurysms with modified stent grafts

Anatomical constraints limit the utility of endovascular therapy with infrarenal stent grafts in approximately 40% of the patients. Fenestrated and branched stent grafts that incorporate the visceral and renal arteries are currently not approved for commercial use in the United States and require at least 6 to 8 weeks for customization. These devices are not currently available as an "off-the-shelf" option to treat complex aneurysms, although recent publications suggest that standardization will be possible in 70% to 80% of patients. Modification of aortic stent grafts with creation of reinforced fenestrations or side branches has been reported and may have a future role in the compassionate treatment of high-risk patients with complex aneurysms who otherwise would not have access to a manufactured device, or for those in need of urgent or emergent repair as in the case of a patient with an impending or contained ruptured aneurysm. This article summarizes the current principles applied for device design, procedure planning, and potential applications of modified stent grafts for urgent treatment of symptomatic or contained ruptured aortic aneurysms.