Repair of a Disconnected Stent-Graft Limb Facilitated by In Situ Fenestration

PURPOSE: To describe the use of in situ fenestration to facilitate management of a disconnected iliac stent-graft limb that could not be repaired by conventional endovascular techniques. TECHNIQUE: An 85-year-old man who had a Zenith endovascular graft deployed 3 years earlier for a 10-cm infrarenal abdominal aortic aneurysm presented with separation of the right iliac stent-graft limb from the main body, resulting in type III endoleak and sac enlargement. The disconnected limb occluded the ostium of the main stent-graft body, blocking all conventional endovascular techniques to traverse the graft limb-main body intersection. To overcome the problem, the cephalad portion of the proximal disconnected limb overlying the main body gate was successfully fenestrated with an endoscopic FNA needle and continuity restored with a Viabahn stent-graft across the balloon-modeled fenestration. CONCLUSION: In situ fenestration of endovascular stent-grafts may be a useful adjunct in performing rescues of late complications in patients not suitable for open repair.