Long-Term Experimental Evaluation of In Situ Laser-Fenestrated Versus Custom-Made Fenestrated Endografts

ISLF fenestrations demonstrated comparable durability to CMD fenestrations after long-term fatigue testing, with distinct advantages in BSG integrity preservation. These findings support ISLF as a viable option for urgent treatment, although further research is warranted to validate these results.Clinical ImpactIn-situ laser fenestration is a feasible technique for urgent complex aortic repair when customized or off-the-shelf devices are unavailable or technically unfeasible. However, long-term mechanical stability and durability under fatigue testing have not been previously evaluated. This study is the first to directly compare the long-term mechanical performance of industry-made custom fenestrations with in-situ laser fenestrations using a fatigue model. Results demonstrate non-inferiority of in-situ laser fenestrations, supporting their use as an effective off-label strategy for emergency or bailout interventions.