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

Background: To present a novel means of overcoming a deviation when treating an aortic arch aneurysm with a physician-modified fenestrated stent-graft. Methods: A 78-year-old man 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. 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. 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.