A standardized physician-modified endograft workflow utilizing the punch card technique and the Hungaroring reinforcement to treat complex abdominal aortic aneurysms.

The physician-modified endograft technique is becoming widely accepted as an alternative to standard fenestrated endovascular aortic repair. We report a streamlined workflow based on a bifurcation endograft, using the punch card and the Hungaroring reinforcement, two novel additions to the armamentarium that might contribute to the safety and durability of such repairs. A cohort of 11 patients was treated with 43 vessels incorporated. The clinical success rate was 100%. No major adverse event or death was recorded at 30 days. The punch card and the novel reinforcement technique might improve the safety and durability of such repairs.