Thoracic Endovascular Aortic Repair for Aortic Arch Aneurysms Using Physician-Modified Endovascular Graft with Pre-Crossing Cannulated Wires for the Left Common Carotid Artery Aortic Arch Aneurysms.

Regarding thoracic endovascular aortic repair involving the aortic arch, fenestration is occasionally employed to maintain blood flow to aortic branches. Pre-cannulation can mitigate the risk of misalignment between the left subclavian artery fenestration and arch branches. However, the left common carotid artery is located in a tortuous area of the arch, making fenestration alignment difficult. We employed a novel pre-cannulation technique to prevent such misalignment in a 73-year-old patient. This technique represents a systematic approach to left common carotid artery fenestration alignment in thoracic endovascular aortic repair, with potential reproducibility in selected cases. This approach requires validation in larger cohorts.