Unique Stent-Graft Modification in Emergency High-Risk Patients for Aortic Arch Pathology

Physician-modified stent-grafts represent a feasible and effective treatment option for high-risk patients with aortic arch pathologies requiring urgent intervention. The technique enables tailored management in cases where off-the-shelf solutions or custom devices are unavailable, offering high technical success and promising mid-term durability. Further multicenter studies are warranted to confirm long-term safety and refine procedural techniques.Clinical ImpactThis study shows that physician-modified stent grafts (PMSGs) are a feasible option for high-risk patients who cannot undergo open surgery or access custom-made devices. Using 3D-printed templates improves fenestration accuracy and arterial alignment. The 100% technical success rate and absence of early mortality indicate strong short-term effectiveness. However, the off-label nature of the technique and lack of standardization require experienced teams and careful patient selection. If confirmed in larger cohorts, PMSGs could become part of emergency aortic treatment protocols and influence future device development.