{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T05:10:13Z","timestamp":1758863413201,"version":"3.44.0"},"reference-count":8,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T00:00:00Z","timestamp":1757980800000},"content-version":"vor","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"KAKENHI","doi-asserted-by":"publisher","award":["22K12826"],"award-info":[{"award-number":["22K12826"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Zone 0 thoracic endovascular aortic repair (TEVAR) remains technically demanding because of limited proximal landing zones and the need to preserve all supra-aortic branches. Conventional strategies\u2014including branched endografts, chimney or snorkel techniques, and hybrid repairs\u2014have been associated with increased risks of stroke, retrograde type A dissection, and perioperative mortality.<\/jats:p>\n               <jats:p>We describe a technique using a physician-modified triple-fenestrated endograft with transfemoral delivery of all bridging covered stents (BCSs) to the brachiocephalic, left common carotid, and left subclavian arteries. Cervical and brachial access was used solely for angiography and minimal catheter manipulation, thereby aiming to reduce cerebral embolization risk.<\/jats:p>\n               <jats:p>A 71-year-old man with a history of coronary artery bypass surgery and reduced left ventricular ejection fraction (31%) presented with fever. Imaging revealed a dissecting aortic aneurysm confined to the arch. Blood cultures were positive for methicillin-susceptible Staphylococcus aureus. After intravenous antibiotic therapy, cultures became negative; however, the aneurysm enlarged. Given the high surgical risk, TEVAR was selected. All BCSs were delivered transfemorally without complications. Postoperative and 1-year follow-up imaging showed no endoleak and a reduction in aneurysm size.<\/jats:p>\n               <jats:p>This approach may offer a less invasive and embolic risk-reducing option for managing arch pathology in high-risk patients.<\/jats:p>","DOI":"10.1093\/icvts\/ivaf209","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T21:37:06Z","timestamp":1758317826000},"source":"Crossref","is-referenced-by-count":0,"title":["Transfemoral Bridging Stent-Graft Delivery in Zone 0 Endovascular Arch Repair With Triple-Fenestrated Endograft"],"prefix":"10.1093","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9282-205X","authenticated-orcid":false,"given":"Hiroaki","family":"Kaneyama","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Keio University School of Medicine , Tokyo, 1608582,","place":["Japan"]},{"name":"Department of Cardiovascular Surgery, Red Cross Ashikaga Hospital , Tochigi, 3260843,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6385-6162","authenticated-orcid":false,"given":"Kenichi","family":"Hashizume","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Keio University School of Medicine , Tokyo, 1608582,","place":["Japan"]},{"name":"Department of Cardiovascular Surgery, Saiseikai Utsunomiya Hospital , Tochigi, 3210974,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshiaki","family":"Yagami","sequence":"additional","affiliation":[{"name":"Department of Radiology, Saiseikai Utsunomiya Hospital , Tochigi, 3210974,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiyoshi","family":"Koizumi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Red Cross Ashikaga Hospital , Tochigi, 3260843,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2308-6404","authenticated-orcid":false,"given":"Koki","family":"Ikebata","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Red Cross Ashikaga Hospital , Tochigi, 3260843,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7204-8148","authenticated-orcid":false,"given":"Takashi","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Red Cross Ashikaga Hospital , Tochigi, 3260843,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masayoshi","family":"Waga","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Red Cross Ashikaga Hospital , Tochigi, 3260843,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0298-4261","authenticated-orcid":false,"given":"Hideyuki","family":"Shimizu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Keio University School of Medicine , Tokyo, 1608582,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,9,16]]},"reference":[{"key":"2025092600364943900_ivaf209-B1","doi-asserted-by":"crossref","first-page":"1709","DOI":"10.1016\/j.jtcvs.2014.02.072","article-title":"Global experience with an inner branched arch endograft: perioperative outcomes and cerebrovascular complications","volume":"148","author":"Haulon","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025092600364943900_ivaf209-B2","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.xjtc.2024.03.003","article-title":"Short-term results of fenestrated physician-modified endografts for type1a endoleak after conventional thoracic endovascular aortic repair","volume":"25","author":"Moqaddam","year":"2024","journal-title":"JTCVS Tech"},{"key":"2025092600364943900_ivaf209-B3","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.ejvs.2024.04.008","article-title":"Physician modified fenestrated endografts for endovascular aortic arch repair in zone 0","volume":"68","author":"Wen","year":"2024","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2025092600364943900_ivaf209-B4","doi-asserted-by":"crossref","first-page":"1602","DOI":"10.1016\/j.jvs.2020.02.017","article-title":"Association of upper extremity and neck access with stroke in endovascular aortic repair","volume":"72","author":"Plotkin","year":"2020","journal-title":"J Vasc Surg"},{"key":"2025092600364943900_ivaf209-B5","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1177\/02184923231168295","article-title":"Safety and efficacy of physician-modified thoracic endovascular aortic repair using a low-profile device for aortic arch lesions","volume":"31","author":"Hashizume","year":"2023","journal-title":"Asian Cardiovasc Thorac Ann"},{"key":"2025092600364943900_ivaf209-B6","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1097\/SLA.0000000000000585","article-title":"Retrograde aortic dissection after thoracic endovascular aortic repair","volume":"260","author":"Canaud","year":"2014","journal-title":"Ann Surg"},{"key":"2025092600364943900_ivaf209-B7","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1016\/j.jtcvs.2021.04.053","article-title":"2021 The American association for thoracic surgery expert consensus document: surgical treatment of acute type A aortic dissection","volume":"162","author":"Malaisrie","year":"2021","journal-title":"J Thorac Cardiovasc 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