A Case of an Abdominal Aortic Aneurysm Treated with Open Surgical Repair in Anticipation of Future TEVAR, Followed by a Physician-Modified Endograft Using an Aortofemoral Conduit for Thoracoabdominal Aortic Aneurysm

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Abdominal aortic aneurysm (AAA) and thoracoabdominal aortic aneurysm (TAAA) (n=1). Intervention: Open surgical repair creating an aortofemoral conduit followed 4 years later by physician-modified fenestrated TEVAR. Primary outcome: Aneurysm exclusion, superior mesenteric artery (SMA) patency, and absence of endoleak at 6 months post-TEVAR.

Q: What does this research mean for the field?

Physician-modified fenestrated TEVAR performed via an aortofemoral conduit previously created during open abdominal aortic aneurysm repair can successfully exclude a thoracoabdominal aortic aneurysm in patients with hostile iliac access. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yusuke Yaoita; Takao Ohki; Kentaro Kasa; Hirotsugu Ozawa; Makiko Omori; Soichiro Fukushima; 馬場 健; Kota Shukuzawa; Masayuki Hara

doi:10.4326/jjcvs.55.271

September 15, 2026Japanese Journal of Cardiovascular SurgeryOpen Access

A Case of an Abdominal Aortic Aneurysm Treated with Open Surgical Repair in Anticipation of Future TEVAR, Followed by a Physician-Modified Endograft Using an Aortofemoral Conduit for Thoracoabdominal Aortic Aneurysm

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Key result

Physician-modified fenestrated TEVAR via aortofemoral conduit successfully excludes 56-mm TAAA with patent SMA.

n=1

Why the study?

Despite advances in low-profile TEVAR devices and sheath performance, selecting an access route remains challenging in patients with concomitant iliofemoral occlusive arterial disease.

Key Points

To describe a planned two-stage strategy using an aortofemoral conduit established during open abdominal aortic aneurysm repair to enable subsequent endovascular repair for a growing thoracoabdominal aneurysm.
A 73-year-old woman presented with a 55 mm abdominal aortic aneurysm (AAA), a 49 mm thoracoabdominal aortic aneurysm (TAAA), and narrow external iliac arteries measuring 6 mm.
The patient first underwent open AAA repair using a Y-graft anastomosed to both common femoral arteries, deliberately creating an aortofemoral conduit for future endovascular access.
Four years later, when the TAAA expanded to 56 mm, TEVAR was performed via the conduit using a physician-modified endograft with a fenestration for the superior mesenteric artery.
The initial open surgical repair required 351 minutes with 2,145 ml blood loss, resulting in patent bypass limbs and discharge on postoperative day 13.
The subsequent TEVAR procedure through the graft conduit required 270 minutes and 250 ml blood loss, achieving aneurysm exclusion with patent visceral branches and no endoleak at 6-month follow-up.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 female patient (aged 73 at initial surgery and 77 at second surgery) with concomitant abdominal and thoracoabdominal aortic aneurysms and narrow external iliac arteries, followed for 4 years between procedures and 6 months post-TEVAR.

I

Intervention

Initial open surgical repair (OSR) of the AAA at age 73 using a bifurcated prosthetic graft (J-Graft, 16-11 mm) anastomosed to the bilateral common femoral arteries to create a permanent aortofemoral conduit, followed 4 years later (at age 77, when TAAA reached 56 mm) by physician-modified fenestrated thoracic endovascular aortic repair (TEVAR) via the conduit, involving celiac artery embolization (Amplatzer Vascular Plug II 8 mm), deployment of a physician-modified Endurant II aortic extension with a superior mesenteric artery (SMA) fenestration, SMA stenting (GORE VIABAHN VBX 6-39), and proximal sealing (GORE TAG TGM343415J).

O

Outcome

Technical success of physician-modified fenestrated TEVAR, aneurysm exclusion/thrombosis, absence of endoleak, and SMA graft patency on computed tomography angiography (CTA) at 6 months postoperatively.surrogate

In patients undergoing open AAA repair who have concomitant thoracoabdominal aneurysms and small iliac arteries, proactively creating an aortofemoral prosthetic conduit provides a safe and effective access route for future complex fenestrated TEVAR.

Limitations

Single patient case report
Risk of over-intervention if life expectancy is uncertain when planning a conduit for future procedures
Increased surgical invasiveness and potential complications from tunneling graft limbs to the femoral arteries during initial open repair
Inappropriate graft limb diameter, length, or excessive kinking after open repair may preclude future conduit use
Uncertain life expectancy may cause additional procedures done in anticipation of future treatment to result in over-intervention.
Potential complications associated with tunneling prosthetic graft limbs to the femoral region.
Increased surgical invasiveness during the initial operation due to the creation of an aortofemoral conduit.
If the diameter or length of the prosthetic graft limbs is inappropriate or excessively kinked, future use as a conduit may be difficult.

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Implication

May facilitate TEVAR access in select patients with hostile iliac anatomy after prior open AAA repair; leaves open need for prospective validation.

Abstract

胸部ステントグラフト内挿術（Thoracic Endovascular Aortic Repair: TEVAR）は近年急速に普及しており，解剖学的要件を満たす胸部下行大動脈瘤では標準治療となった．TEVAR用デバイスのlow profile化とシース性能の向上は著しいものの，腸骨動脈から大腿動脈の閉塞性動脈病変を伴う症例では，アクセスルートの選択に難渋する．症例は77歳，女性，73歳時に最大短径55 mmの腹部大動脈瘤（Abdominal Aortic Aneurysm: AAA）と最大短径49 mmの胸腹部大動脈瘤（Thoracoabdominal aortic aneurysm: TAAA）を併発していた．将来的にTAAAに対するTEVARの施行が想定されたが，両側外腸骨動脈が狭小であり，アクセス血管としての使用は困難と考えられた．AAAに対する初回手術に際して，人工血管置換術を選択し，将来的なTEVARにおけるアクセスルートとしてのaortofemoral conduitを作製した．4年後の77歳時に最大短径56 mmまで拡大したTAAAに対して，初回手術で作製したconduitを使用することで自作開窓型TEVARを完遂し，良好な結果を得た．

Discussion

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Cite This Study

Yaoita et al. (2026) conducted a case report in Abdominal aortic aneurysm (AAA) and thoracoabdominal aortic aneurysm (TAAA) (n=1). Open surgical repair creating an aortofemoral conduit followed 4 years later by physician-modified fenestrated TEVAR was evaluated on Aneurysm exclusion, superior mesenteric artery (SMA) patency, and absence of endoleak at 6 months post-TEVAR. Physician-modified fenestrated TEVAR via a previously created aortofemoral conduit successfully excluded a 56 mm TAAA with no endoleak and a patent SMA at 6 months.

synapsesocial.com/papers/6af0e999de503f3774140a48 https://doi.org/10.4326/jjcvs.55.271

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A Case of an Abdominal Aortic Aneurysm Treated with Open Surgical Repair in Anticipation of Future TEVAR, Followed by a Physician-Modified Endograft Using an Aortofemoral Conduit for Thoracoabdominal Aortic Aneurysm

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

A Case of an Abdominal Aortic Aneurysm Treated with Open Surgical Repair in Anticipation of Future TEVAR, Followed by a Physician-Modified Endograft Using an Aortofemoral Conduit for Thoracoabdominal Aortic Aneurysm

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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