Calculation of stent-graft fenestration points for supraceliac aortic endografting: design and application of universal calibrated models

Background. Fenestrated abdominal aortic repair is a minimally invasive solution in the treatment of juxtarenal aneurysms and pararenal aneurysms. After fenestration, the success of renal branch catheterization depends on the correct positioning of the stent-graft relative to the artery mouth. At the same time, with more fenestrations the success of arterial catheterization depends on the exact alignment of fenestras. The article suggests methods for determining endograft fenestration points for fenestrated abdominal aortic repair of Juxtarenal aneurysms and pararenal aneurysms using universal models with a dimensional grid and a measuring ruler printed on a 3D printer. The proposed approaches, both individually and together, can increase the accuracy of selecting points for endograft fenestration, which may improve the results of Fenestrated abdominal aortic repair Juxtarenal aneurysms and pararenal aneurysms.

Aim: To assess the effectiveness of fenestration of an endovascular prosthesis using additional universal devices (universal aortic models and a measuring ruler) to select the fenestration point during endovascular prosthetics of abdominal aortic aneurysms with juxtarenal and pararenal localization.

Material and Methods. Aortic models with a dimensional grid and a measuring ruler were designed, followed by the production of models and rulers with 3D printing. The study involved 7 male patients with juxtarenal and pararenal abdominal aortic aneurysms who underwent primary elective endovascular aortic repair using fenestration on the operating table (performing 2 fenestration) using aortic models and an stent-graft measuring ruler.

Results. Technical and procedural success is achieved in 100% of cases. The target or close to the target position was achieved in all patients. There were no positional errors. No endoliths of types 1A and 3 were registered. There were no difficulties in cannulation and endograft insertion into the renal arteries.

Conclusion. The technology of endograft fenestration using additional universal tools (universal models, measuring ruler) for selecting fenestration points in juxtarenal and pararenal endovascular repair can be considered an effective, cost-efficient alternative, offering the potential to reduce waiting times for intervention in patients at high risk of aneurysm rupture.

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