Patient-individualized treatment concept in a case of a juxtarenal AAA repair with limited transfemoral access using custom-made fenestrated aortic endografts

Endovascular techniques have become the preferred method for treating complex aortic aneurysms, but some cases require individualized strategies beyond manufacturer specifications. We report a 62-year-old male with a 64 mm juxtarenal abdominal aortic aneurysm, right above-knee amputation, and dependence on the right hypogastric artery. The patient's complex anatomy necessitated a custom solution including fEVAR. Access was gained through the left femoral and brachial arteries due to an occluded right external iliac artery. The right hypogastric artery was treated with covered stents via transbrachial access. This case highlights the potential for treating complex aortic aneurysms using patient-individualized endoprostheses and creative endovascular solutions outside standard instructions-for-use.