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<p>Physician-modified fenestrated/inner-branched endovascular aortic repair (PM-F/iBEVAR) is a minimally invasive alternative for thoracoabdominal aortic aneurysms, offering anatomical adaptability via inner branches and fenestrations. This stepwise protocol details stent-graft modification, preloaded wires, and diameter-reducing ties, enhancing cannulation and procedural control. Inner branches facilitate the cannulation of the target vessels by providing increased clearance from the aneurysmal wall, while greater overlap with bridging stents may help reduce the risk of type III endoleaks. Despite promising outcomes, significant variations in technique and the lack of standardized protocols among institutions underscore the need for further refinement and data from ongoing multicenter studies. PM-F/iBEVAR offers a feasible and effective alternative to open surgical repair in selected patients. Wider adoption may be facilitated by the standardization of techniques and the development of evidence-based clinical guidelines.</p>

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Stepwise protocol for physician-modified fenestrated/inner-branched endovascular aortic repair for a thoracoabdominal aortic aneurysm

  • 期刊论文

  • 发表日期：

    2026年3月26日

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  • Shingo Tsushima,
  • Tsuyoshi Shibata,
  • Yutaka Iba,
  • Kenta Yoshikawa,
  • Hirokazu Sugiura,
  • Shun Hayasaka,
  • Tomohiro Nakajima,
  • Junji Nakazawa,
  • Ayaka Arihara,
  • Kenichi Kato,
  • Shigeki Komatsu,
  • Masato Yonemori,
  • Hajime Maeda

摘要

Physician-modified fenestrated/inner-branched endovascular aortic repair (PM-F/iBEVAR) is a minimally invasive alternative for thoracoabdominal aortic aneurysms, offering anatomical adaptability via inner branches and fenestrations. This stepwise protocol details stent-graft modification, preloaded wires, and diameter-reducing ties, enhancing cannulation and procedural control. Inner branches facilitate the cannulation of the target vessels by providing increased clearance from the aneurysmal wall, while greater overlap with bridging stents may help reduce the risk of type III endoleaks. Despite promising outcomes, significant variations in technique and the lack of standardized protocols among institutions underscore the need for further refinement and data from ongoing multicenter studies. PM-F/iBEVAR offers a feasible and effective alternative to open surgical repair in selected patients. Wider adoption may be facilitated by the standardization of techniques and the development of evidence-based clinical guidelines.