Use of the Electrified Wire Technique for In Situ Fenestration Creation Within a Branch Bridging Stent.

Abstract

Purpose: To present the use of the electrified wire technique as bailout for target vessel (TV) branch preservation after unintended coverage by a bridging stent during branched endovascular repair (bEVAR).

Technique: A 73-year-old male, previously treated with thoracic endovascular aortic repair and Provisional Extension to Induce Complete Attachment Technique (PETTICOAT) for type B aortic dissection, presented with a 68 mm type V thoracoabdominal aortic aneurysm. The patient presented an anatomic variation with a common trunk for the superior mesenteric artery (SMA) and celiac artery (CA). After a previously failed open surgical attempt, a triple-branch custom-made device (2 renal branches and 1 for the SMA/CA trunk) was chosen. Endograft deployment and TV catheterization were uneventful, until an unintended coverage of the CA occurred, due to bridging stent unmount. Using the electrified wire technique, an in situ fenestration was created into the CA/SMA trunk covered bridging stent to preserve CA patency. A bare metal stent was used for CA revascularization. Renal arteries were catheterized and bridged as planned. The 6-month computed tomography angiography confirmed TV patency.

Conclusion: The electrified wire technique may be used as bailout for in situ fenestration creation in unintended coverage of early TV side-branches.Clinical ImpactAnatomic variations may increase the technical complexity of branched endovascular aortic repair while technical pitfalls related to target vessel preservation may demand the application of bailout techniques. In this case, the electrified wire technique was used to create an in situ fenestration within the bridging stent of a celiac artery (CA) and superior mesenteric artery common trunk (anatomic variation), after bridging stent unmount during advancement and CA unintended coverage.