In Vivo Fenestration During Endovascular Aneurysm Repair
Abdominal aortic aneurysms have been managed endovascularly during the past 10–15 years. The main limitations in the ability to treat patients endovascularly are anatomical constraints. The most important factors are aortic neck and iliofemoral access anatomy. This chapter describes a technique to overcome a short neck with a renal artery originating from the aneurysm that does not allow enough proximal landing zone for stent grafting. Several techniques have been developed to overcome this obstacle, including custom-made grafts with fenestrations, back table fenestration, and parallel graft placement. This chapter discusses the in vivo graft fenestration technique to preserve the renal artery lumen during the endovascular repair of an abdominal aortic aneurysm.