Language
English
Publication Date
10-26-2025
Journal
Journal of Endovascular Therapy
DOI
10.1177/15266028251384906
PMID
41139824
Abstract
Objective: The objective of the study is to describe a novel bifurcated in-stent in situ technique (BIS2T) for creation of a bifurcated bridging stent-graft system to target 2 vessels using a single directional branch during complex endovascular aortic aneurysm.
Technique: The technique uses 3 balloon-expandable stent-grafts. The first supporting stent-graft is deployed from the directional branch into the first target vessel or aneurysm sac. A reentry catheter is used to create an in situ fenestration in the first stent-graft, which is predilatated with a 3 mm 0.014 inch angioplasty balloon. This is exchanged for a 0.035 inch 5 Fr catheter and guidewire which is used for catheterization of the second target vessel via the in situ fenestration. The docking area of the first stent-graft is predilated. The second stent-graft is deployed into the second target with >1 cm overlap into the first stent-graft, followed by a matching third stent-graft in a kissing stent fashion to reinforce the bifurcation and achieve a "D shape" stent-graft configuration.
Results: The BIS2T was used to treat 2 patients. Neither experienced complications or endoleaks, and both had patent branches on follow-up computed tomography angiography.
Conclusions: The BIS2T is a feasible option to incorporate 2 target vessels via a single directional branch.Clinical ImpactTarget vessel anatomy is a frequent limitation for successful endovascular incorporation using fenestrations or directional branches during complex endovascular aortic aneurysm repair. Numerous anatomical variations such as aberrant or accessory vessels, common celio-mesenteric trunks, or extension of the aneurysm/dissection into a target vessel may preclude successful incorporation using standard endovascular techniques. This technical note describes a novel bifurcated in-stent in situ technique (BIS2T) for the creation of a bifurcated bridging stent-graft system to target 2 vessels using a single directional branch. This approach may enable target vessel incorporation in challenging anatomical situations that might otherwise preclude endovascular treatment or require intentional artery coverage.
Keywords
case report, complex aortic aneurysms, fenestrated and/or branched endovascular aneurysm Repair (FB-EVAR), in situ fenestration, parallel stent-grafts
Published Open-Access
yes
Recommended Citation
Paludetto, Gustavo; Mesquita, Lethicia; Pagnin Schmid, Bruno; et al., "Bifurcated In-Stent in Situ Technique for Creation of a Bifurcated Bridging Stent-Graft System to 2 Target Vessels Using a Single Directional Branch: A Report of 2 Cases" (2025). Faculty, Staff and Students Publications. 6170.
https://digitalcommons.library.tmc.edu/baylor_docs/6170