Mixed reality-assisted physician-modified endograft fenestration for urgent repair of a complex infrarenal abdominal aortic aneurysm: First-in-the-world case.

Abstract

Mixed reality-guided endovascular repair using physician-modified devices offers an innovative solution for urgent repair of complex abdominal aortic aneurysms. We present the first case treated in this manner in a 77-year-old man with a symptomatic infrarenal abdominal aortic aneurysm and hostile proximal neck. A three-dimensional aortic model obtained from computed tomography angiography was overlaid onto a Treo graft via a Meta Quest 3 headset for precise on-table ostial marking and fenestration. After modification and resheathing, the endograft was advanced using fusion and angiography guidance. The endograft was then deployed, demonstrating perfect matching between each fenestration and the target vessels. A final aortogram confirmed patency of visceral branches and absence of endoleak. Mixed reality guidance enables accurate, rapid customization when patient-specific company-manufactured devices are unavailable, offering a viable urgent alternative for fenestrated endovascular repair.