Endovascular Conversion of a Failed Fenestrated Anaconda Endograft Using a Branched Custom-Made Device

PURPOSE: To present the successful resolution of a type Ia endoleak in a patient previously treated with a fenestrated Anaconda endograft using a custom-made branched endograft. TECHNIQUE: The limited working length and the retrograde orientation of the renal arteries due to caudal migration of the previous fenestrated endograft required a unique custom-made 5-branched graft configuration designed by COOK Medical (Bloomington, Indiana). This design featured 2 short (10-mm) retrograde branches for the renal arteries, along with an additional branch extending from the main body of the graft to accommodate the contralateral limb of the previous endograft. A .014″ wire was used as a stabilizing "pull-through wire" for the Fustar sheath, providing adequate stability for the challenging catheterization of the target vessels. CONCLUSION: Custom-made branched endovascular aneurysm repair after failed fenestrated Anaconda device is a feasible solution. Thorough planning and complex endovascular techniques may be necessary.Clinical ImpactThis technical report highlights the significant challenges associated with endovascular reintervention following failure of fenestrated endografts. Such reoperations often require customized grafts and advanced endovascular skills. Our experience demonstrates that with appropriate planning, branched endovascular repair (bEVAR) can be a feasible and effective solution for managing failed fenestrated endovascular aneurysm repair (fEVAR) apart from open conversion.