{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T10:03:25Z","timestamp":1789985005751,"version":"4.0.1"},"reference-count":21,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>(1) Background: Laser in situ fenestration (L-ISF) is an endovascular technique used to preserve target vessel patency in urgent or emergency endovascular aortic repair when fenestrated\/branched solutions are unavailable or unsuitable, or as a bailout technique for fenestration or branch misalignment. This on-bench study compared different laser energy levels in five commercially available endografts to assess fabric damage and evaluate fenestration quality, dimensions, and recoil. (2) Methods: A total of 102 fenestrations were created using a 2.0 mm excimer laser catheter at low (45 mJ\/mm2) or high (60 mJ\/mm2) energy levels and dilated with a 6 mm plain balloon in five polyester endografts (Zenith Alpha, RelayPro, Endurant IIs, Valiant Captivia, Hercules). High-magnification microscopy assessed morphology and fabric damage after puncture, after dilation, and after 24 h. Quantitative measurements included diameters, area, and recoil under standardized study conditions. (3) Results: Valiant exhibited clearer puncture margins and no bulging; Hercules showed frequent tearing and more bulging and warp-aligned recoil at high energy. In Endurant IIs, low-energy L-ISF produced larger diameters and area but also greater recoil. RelayPro revealed stronger surface recoil with high energy. (4) Conclusion: Both low- and high-energy L-ISF were feasible across all tested grafts. A low-energy approach may be preferable for Endurant IIs, potentially reducing the risk of bridging stent graft stenosis.<\/jats:p>","DOI":"10.3390\/bioengineering13091085","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T08:03:47Z","timestamp":1789977827000},"page":"1085","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Laser Energy Levels on In Situ Fenestrations of Aortic Stent Grafts: An On-Bench Study"],"prefix":"10.3390","volume":"13","author":[{"given":"Teodora","family":"Ormandzhieva","sequence":"first","affiliation":[{"name":"Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Goettingen, 37075 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5600-2333","authenticated-orcid":false,"given":"Florian","family":"Elger","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Goettingen, 37075 G\u00f6ttingen, Germany"},{"name":"Department of Vascular Medicine (Vascular and Endovascular Surgery), DRK Kliniken Berlin, 13359 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Marcello","family":"Silvano","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Goettingen, 37075 G\u00f6ttingen, Germany"},{"name":"Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"given":"Bernd","family":"Niemann","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Goettingen, 37075 G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"conceptualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1101-3176","authenticated-orcid":false,"given":"Eberhard","family":"Grambow","sequence":"additional","affiliation":[{"name":"Department of Cardiac, Thoracic and Vascular Surgery, University Medical Center Goettingen, 37075 G\u00f6ttingen, Germany"},{"name":"Department of General, Visceral, Thoracic, Vascular and Transplantation Surgery, University Medical Center Rostock, 18057 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1583\/12-4175.1","article-title":"In vitro fenestration of aortic stent-grafts: Implications of puncture methods for in situ fenestration durability","volume":"20","author":"Riga","year":"2013","journal-title":"J. Endovasc. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.avsg.2021.05.021","article-title":"Experimental Analysis of In Situ Fenestration of Endovascular Stent-Grafts: Comparison between Needle and Laser Puncture","volume":"77","author":"Zeng","year":"2021","journal-title":"Ann. Vasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1016\/j.ejvs.2023.01.038","article-title":"Midterm Outcomes of Antegrade In Situ Laser Fenestration of Polyester Endografts for Urgent Treatment of Aortic Pathologies Involving the Visceral and Renal Arteries","volume":"65","author":"Gaudin","year":"2023","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e201900032","DOI":"10.1002\/jbio.201900032","article-title":"In situ diode laser fenestration: An ex-vivo evaluation of irradiation effects on human aortic tissue","volume":"12","author":"Piazza","year":"2019","journal-title":"J. Biophotonics"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1177\/1526602818772311","article-title":"Laser Fenestration of Aortic Stent-Grafts Followed by Noncompliant vs. Cutting Balloon Dilation: A Scanning Electron Microscopy Study","volume":"25","author":"Lin","year":"2018","journal-title":"J. Endovasc. Ther."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1177\/15266028221119315","article-title":"In Situ Laser Fenestration Technique: Bench-Testing of Aortic Endograft to Guide Clinical Practice","volume":"31","author":"Grima","year":"2022","journal-title":"J. Endovasc. Ther."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1109\/RBME.2021.3085484","article-title":"A systematic review on methods and tools for the in situ fenestration of aortic stent-graft","volume":"16","author":"Piazza","year":"2023","journal-title":"IEEE Rev. Biomed. Eng."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2739","DOI":"10.1177\/15266028251350485","article-title":"Long-Term Experimental Evaluation of In Situ Laser-Fenestrated Versus Custom-Made Fenestrated Endografts","volume":"33","author":"Elger","year":"2026","journal-title":"J. Endovasc. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.1177\/15266028241284373","article-title":"Transprosthetic Fenestration With Electrified Wires. Experimental Evaluation of Three Multifilament Endografts","volume":"33","author":"Torsello","year":"2026","journal-title":"J. Endovasc. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Silvano, M., Torsello, G.B., Ormandzhieva, T., Torsello, G.F., and Elger, F. (2025). In Vitro Comparison of Retrograde In Situ Fenestration Using a Re-entry Catheter vs Electrified Guidewire in Thoracic Endografts. J. Endovasc. Ther., 15266028251403924.","DOI":"10.1177\/15266028251403924"},{"key":"ref_11","first-page":"100417","article-title":"Analysis of cutting balloon versus plain balloon dilatation after electrified wire in situ fenestration","volume":"7","author":"Silvano","year":"2026","journal-title":"JVS-Vasc. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1177\/1526602820981980","article-title":"Optimal In Situ Fenestration Technique With Laser Perforation and Balloon Dilation for Aortic Stent-Grafts","volume":"28","author":"Lin","year":"2021","journal-title":"J. Endovasc. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.ejvs.2015.11.014","article-title":"Laser Generated In situ Fenestrations in Dacron Stent Grafts","volume":"51","author":"Sonesson","year":"2016","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/j.ejvs.2018.05.014","article-title":"In Situ Antegrade Laser Fenestrations During Endovascular Aortic Repair","volume":"56","author":"Fabre","year":"2018","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1002\/polc.5070200118","article-title":"The structural mechanics of fibers","volume":"20","author":"Hearle","year":"2007","journal-title":"J. Polym. Sci. Part C Polym. Symp."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Angelova, Y.P. (2020). Factors influencing the laser treatment of textile materials: An overview. J. Eng. Fibers Fabr., 15.","DOI":"10.1177\/1558925020952803"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/S1078-5884(03)00341-1","article-title":"Influence of the textile structure on the degradation of explanted aortic endoprostheses","volume":"27","author":"Dieval","year":"2004","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"368","DOI":"10.3928\/1081-597X-19920901-07","article-title":"A comparison of excimer laser (308 nm) ablation of the human lens nucleus in air and saline with a fiber optic delivery system","volume":"8","author":"Martinez","year":"1992","journal-title":"Refract Corneal Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1002\/(SICI)1096-9101(1996)18:4<381::AID-LSM7>3.0.CO;2-O","article-title":"Excimer laser induced bubble: Dimensions, theory, and implications for laser angioplasty","volume":"18","author":"Jansen","year":"1996","journal-title":"Lasers Surg. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.ejvs.2018.03.016","article-title":"An experimental study of laser in situ fenestration of current aortic endografts","volume":"56","author":"Jayet","year":"2018","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.jvs.2019.09.055","article-title":"Outcomes of target vessel endoleaks after fenestrated-branched endovascular aortic repair","volume":"72","author":"Tenorio","year":"2020","journal-title":"J. Vasc. 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