Preloaded Physician-Modified Thoracic Endovascular Aortic Repair to Achieve Left Subclavian Artery Fenestration Alignment in Zone 2

Constructing a PMEG with diameter-reducing ties and a preloaded LSA fenestration to establish a through-and-through wire could facilitate precise alignment, improving procedural consistency over time of fenestrated TEVAR in zone 2.Clinical ImpactEndovascular methods for left subclavian artery (LSA) preservation during thoracic endovascular aortic repair (TEVAR) in zone 2 are gaining in popularity. One promising endovascular treatment option is construction of a fenestrated physician-modified endovascular graft (PMEG). Achieving precise alignment between the fenestration and LSA can be challenging. The current report demonstrates a technique to preload the LSA fenestration to establish a through-and-through wire, which, in combination with diameter reducing ties, can potentially aid in achieving consistent results by obtaining a perfect alignment in a quick manner.