How I Do It: Cook Zenith Flex Scallop and Fenestration Modification for JAAA

This educational video demonstrates the back-table modification of an off-the-shelf Cook Zenith Flex bifurcated aortic endograft using physician-created scallops and fenestrations to facilitate urgent endovascular treatment of patients with juxtarenal aortic aneurysms. The video provides a step-by-step overview of graft planning, device modification, fenestration creation, reinforcement techniques, and target-vessel access strategies. The technique can be adapted to incorporate two or three fenestrations with a proximal scallop to extend the seal zone when custom-made devices are not immediately available. Originally presented at the Society for Vascular Surgery Vascular Annual Meeting (VAM) 2023 and subsequently featured through the SVS CONNECT educational platform. Faculty Jesús Porras-Colón, MD Kyongjun B. Lee, MD Bala Raman, MD Keywords: physician-modified endograft (PMEG), fenestrated EVAR, FEVAR, juxtarenal aneurysm, Cook Zenith Flex, endovascular aneurysm repair, vascular surgery, aortic surgery, endograft modification, back-table modification, SVS CONNECT, VAM 2023.Participants may complete the associated course material and assessment on SVS CONNECT to obtain CME credit. https://vasculearn.vascular.org/conte... Disclosure: This content is intended for educational purposes only. No industry sponsorship or financial support was received for the production of this video. The techniques described should be performed only by appropriately trained physicians and in accordance with institutional policies, regulatory requirements, and professional guidelines. #VascularSurgery #SVS #VAM2023 #SVSConnect #FEVAR #PMEG #AorticSurgery #EndovascularSurgery #CookZenith #EVAR