Physician Modified Endograft For Complex Aortic Aneurysm Repair

"Modification~* Deploy the graft on the sterile, surgical table~* Mark out on the graft the locations of the fenestrations on the graft adjusting as necessary~* Using handheld electrocautery, fashion the fenestration in the appropriate location on the moistened graft material in order to prevent inadvertent progression of the fenestration size~* If the fenestration is going to remain as such, then a snare is used to fashion the marker on the fenestration with 5-0 stitch~* If the fenestration is going to be made into a branch, then an appropriately sized, self-expanding stent is beveled and fashioned to be 15 mm long and sewn to the fenestration in addition to a snare with the 5-0 stitch~* Two orientation markers are placed at the proximal edge and distal edge of the graft consisting of portions of the snare sewn to the anterior portion of the graft in a J fashion with a 5-0 stitch"