# Unstented large fenestration for close target vessel ostia: Long-term follow-up

## TL;DR

A custom endograft with a large unstented fenestration successfully preserved a celiac trunk variation and showed good results after 10 years.

## Contribution

Demonstrates long-term success of an unstented large fenestration in a custom endograft for a rare celiac trunk variation.

## Key findings

- The 10-year follow-up showed patency of all target vessels and no device migration.
- The unstented large fenestration remained functional without complications.
- Custom devices offer effective solutions for complex aortic anatomies.

## Abstract

To report the 10-year follow-up of a patient managed with a custom-made fenestrated endograft, including a large fenestration for the preservation of a celiac trunk (CT) anatomic variation.

In 2014, a 75-year-old female was treated endovascularly for descending thoracic and visceral aortic pseudoaneurysms (PA). Due to a celiac trunk (CT) anatomic variation, consisting of separate origins of the hepatic and splenic artery, a custom-made four-fenestrated endograft was planned, including a large fenestration (18 × 10 mm) for CT preservation. Balloon-expandable covered stents bridged all target vessels (TVs), except the large fenestration, which was left unstented. Imaging at 10 years showed patency of TVs, no signs of instability or device migration and complete PA exclusion.

Using a patient-specific device for complex endovascular aortic repair provided favorable extended follow-up outcomes. An unstented large fenestration remained patent during 10 years of follow-up. This case highlights the importance of individualized approach in complex aortic pathologies.