Abstract
The term physician-modified endovascular graft (PMEG) has been coined to describe on-table modifications of polyester and PTFE-based endografts to treat complex aortic aneurysms. These modifications include fenestrations, internal or external branches, and the addition of pre-catheterization wires or diameter-reducing ties. PMEGs were first used and gained widespread acceptance due to limited access to manufactured devices, time delay required for customization, and high cost of fenestrated and branched endografts. Its primary indication will likely be in the urgent or emergent treatment of higher-risk patients with rapidly expanding and ruptured aneurysms, who are not ideal anatomical candidates for a manufactured off-the-shelf endograft or who cannot await for a patient-specific manufactured device. This chapter summarizes the techniques of endograft modification and implantation for devices using Cook Zenith polyester or Gore Excluder PTFE-based stents.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Suggested Reading
Greenberg R, Eagleton M, Mastracci T. Branched endografts for thoracoabdominal aneurysms. J Thorac Cardiovasc Surg. 2010;140(6):S171–8.
Haulon S, D’Elia P, O’Brien N, Sobocinski J, Perrot C, Lerussi G, et al. Endovascular repair of thoracoabdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2010;39(2):171–8.
Mastracci TM, Greenberg RK, Eagleton MJ, Hernandez AV. Durability of branches in branched and fenestrated endografts. J Vasc Surg. 2013;57(4):926–33.
Oderich GS, Ricotta J. Modified fenestrated stent-grafts: device design, modifications, implantation, and current applications. Perspect Vasc Surg Endovasc Ther. 2009;21(3):170–2.
Oderich GS, Farber MA, Sanchez LA. Urgent endovascular treatment of symptomatic or contained ruptured aneurysms with modified stent grafts. Perspect Vasc Surg Endovasc Ther. 2011;23(3):186–94.
Oderich GS, Fatima J, Gloviczki P. Stent graft modification with mini-cuff reinforced fenestrations for urgent repair of thoracoabdominal aortic aneurysms. J Vasc Surg. 2011;54(5):1522–6.
Oderich GS. Technique of adding a diameter-reducing wire to the modified TX2 fenestrated stent graft. Vascular. 2010;18(6):350–5.
Oderich GS, Mendes BC, Correa MP. Preloaded guidewires to facilitate endovascular repair of thoracoabdominal aortic aneurysm using a physician-modified branched stent graft. J Vasc Surg. 2014;59(4):1168–73.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Mayo Foundation for Medical Education and Research
About this chapter
Cite this chapter
Oderich, G.S., Ribeiro, M.S. (2017). Techniques of Physician-Modified Endovascular Grafts (PMEGs) for Incorporation of Renal Mesenteric Arteries. In: Oderich, G. (eds) Endovascular Aortic Repair. Springer, Cham. https://doi.org/10.1007/978-3-319-15192-2_45
Download citation
DOI: https://doi.org/10.1007/978-3-319-15192-2_45
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-15191-5
Online ISBN: 978-3-319-15192-2
eBook Packages: MedicineMedicine (R0)