This case report describes a 79-year-old man with a symptomatic type 1a endoleak after chimney EVAR. A Prince of Songkla University team designed a physician-modified endograft with a common channel for both renal arteries and a fenestration for the superior mesenteric artery, achieving endoleak exclusion with patent branches.
Key findings
- Completion angiography showed endoleak exclusion without branch compromise. The patient spent one day in intensive care and was discharged uneventfully. At eight months, visceral branches remained patent, stent position was stable, and no recurrent endoleak was seen. All evidence derives from one patient.
Why this matters globally
PMEGs may offer an option in urgent or anatomically unsuitable cases when custom devices are unavailable in time. A common-channel design may address spatial constraints, but it demands highly experienced teams, patient-specific planning, and jurisdiction-specific governance.
Thai researcher contribution
The Prince of Songkla University vascular team designed and performed the complex intervention in Thailand and reported its technical details and follow-up, adding experience from an Asian tertiary center.
Limitations to consider
This is a one-patient report with no comparator and only eight months of follow-up. Rare complications, durability, and comparative performance versus open surgery or custom-manufactured devices cannot be assessed. Physician modification carries specialized risks and regulatory considerations.
Verify the original sources
International Journal of AngiologyRead the original article↗DOI: 10.1055/a-2902-3473