Objective:

To highlight the importance of energy application duration during electrified wire in situ fenestration (EWISF) and its potential impact on procedural outcomes.

Approach:

• Patient Case: An 89-year-old man with a 54-mm pararenal abdominal aortic aneurysm underwent endovascular repair using EWISF for left renal artery stenosis.
• Procedure Details: The procedure involved catheterization, stent placement, and the application of radiofrequency energy to achieve graft perforation.
• Energy Application: A prolonged application of radiofrequency energy (approximately 2 seconds at 40 W) was crucial for successful catheter passage through the fenestration.

Key Findings:

• Prolonged application of radiofrequency energy improved the success of catheter advancement through the graft perforation.
• The procedure was completed successfully with no residual endoleak after necessary adjustments.

Interpretation:

The study indicates that the duration of energy application during EWISF can affect procedural outcomes.

Limitations:

• The case study is based on a single patient, limiting generalizability.
• Technical challenges in applying EWISF to visceral vessels were noted, including difficulties in catheter advancement.

Conclusion:

The findings indicate that careful management of energy application duration is critical in EWISF procedures.