Technique for treating complex aneurysms with Hercules stent graft modified by the surgeon

Endovascular treatment of thoracoabdominal aneurysms with fenestrated stent grafts expands its applicability because of good technical results. However, stent graft customization requires an average of 6 to 12 weeks, which makes this technique ineligible for symptomatic or ruptured aneurysms. Authors advocate perioperative fenestration by the surgeon, allowing this technique to be used for emergency cases with good results and favorable prognosis. This article describes a technique for intraoperative changes of the Hercules stent graft (MicroPort Scientific Corporation, Shanghai, China) to include the ostia of visceral arteries by making fenestrations and scallops, with a temporary diameter-reducing wire as a further modification to facilitate positioning and catheterization of fenestrations with guidewires.