Radiofrequency Perforation System for in Vivo Antegrade Fenestration of Aortic Stent-Grafts

Purpose: To evaluate the ability to create in vivo antegrade fenestrations (IVAF) using a radiofrequency probe in juxtarenal aortic stent-grafts to preserve the patency of renal arteries. Methods: Modified stent-grafts with an unsupported fenestration area were deployed in the juxtarenal aorta of 2 25-kg dogs. Prior to deployment, both renal arteries were marked with detachable coils that were later removed (dog 1) or with hydrophilic catheters (dog 2). After deployment, a radiofrequency probe was used to perforate the graft. If puncture was successful, attempts were made to pass guidewires into the renal arteries for balloon dilation and stenting of the graft perforation. Doppler ultrasound scans of the renal arteries were taken after 1 week. Doppler ultrasound and angiography were repeated prior to autopsy and macroscopic analysis at 1 month. Results: Fenestration was attempted in 3 renal arteries (1 in dog 1 and 2 in dog 2). It was successful in 2 renal arteries but required 6 attempts in dog 1 and 3 in dog 2. The failed case was related to the position of a stent-graft strut close to the fenestration area. One stent thrombosis was seen during follow-up, while the other fenestrated artery remained patent. No stent fracture was encountered during follow-up. Conclusion: This radiofrequency device allowed successful fenestration but was difficult to control. Technical improvements are required to improve clinical success and patency.