Kiattisak Hongku
Current Position
Division of Vascular Surgery, Siriraj Hospital, Mahidol University, Thailand
Thoracic Aorta (II) Session

Topic: Totally endovascular treatment of TAAA using a physician-modified thoracic endograft for treatment of TAAA


Endovascular repair has become an established and standardized treatment of TAAA. Fenestration and branched endograft are the configurations of choice for target vessel incorporation available in both custom-made (CMD) and off-the-shelf (OTS) devices. Ideally, CMD is device of choice if available, however the manufacturing turn-around period is its major drawback. The OTS devices are developed to address this constraint, but they are also limited by anatomical suitability and availability of devices. Physician-modified endograft (PMEG) is an alternative off-the-shelf option constructed on the well-established principle of endograft branching with fenestration or branch cuffs. This is significantly valuable in the urgent situations where the CMD is not readily available, and the OTS device is also unavailable or anatomically unsuitable. The outcomes of PMEGs have been demonstrated in all aortic territories, especially for juxtarenal AAA where positive outcomes from IDE trials were promising. Despite of those encouraging results, the lack of standardized configurations and long-term durability of the modified endograft are concerned. New technologies such as 3D printing and automated software are designed and introduced to facilitate PMEG construction, but they are still subjected to forementioned limitations. Case selection and operators’ experiences are among the important factors affecting the outcomes of this kind of procedure.