In the article on in vitro fenestration of aortic stent-grafts in this issue of the JEVT, Riga et al. describe a benchtop process to perform needle puncture fenestrations through the polytetrafluoroethylene (PTFE) and Dacron material of aortic endografts. Although the modification of endografts to accommodate anatomy, which is not addressed by currently available devices, is not novel, these modifications are generally performed pre-implan-tation. The object of this study was to provide a very preliminary analysis of the potential for post-implantation fenestration of an endo-graft. Contrary to what is suggested by the title, there is unfortunately no implication for durability; based on this very elemental work involving needle perforations of graft material, the authors can in no way predict what long-term changes will look like, particularly with relation to graft fatigue. There are distinct applications for creating in situ fenestrations, and this is evidenced by the plethora of publications to date on the use of fenestrated devices, as well as the development of chimney, snorkel, and periscope techniques. In short, this indeed suggests that modifications to off-the-shelf devices may provide some clinical benefit, particularly in the context of troubleshooting a malpositioned en-dograft or in emergency/urgent procedures where an off-the-shelf solution is not available.
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