Physician-modified aortic cuff to "stabilize" paravisceral aortic thrombus and minimize risk of distal embolization during pararenal aneurysm repair with fenestrated stent graft.

As technology and surgeon experience evolve, endovascular repair of complex abdominal aortic aneurysms is often preferred in appropriately selected patients. However, the presence of pedunculated aortic thrombus represents a relative contraindication for endoluminal therapy due embolization risks. Here, we present a 68-year-old woman with a 5.8-cm pararenal aortic aneurysm associated with pedunculated aortic thrombus. She was treated with a modified Cook-Zenith aortic cuff to first entrap the aortic thrombus, followed by treatment of the aneurysm with a modified Z-FEN graft. This cuff modification provides a novel approach to deal with such luminal thrombus.