Complex Endovascular Aortic Reconstruction: An Update

Abstract

Endovascular repair of complex abdominal and thoracoabdominal aortic aneurysms (TAAAs) has gained widespread acceptance owing to decreased rates of early morbidity and mortality compared to open surgical repair (OSR).1, 2 Stent grafts designed with fenestrations and directional branches allow for complete exclusion of aortic aneurysms involving the visceral and renal arteries without compromising proximal and distal seal zones. In the most recent European Society of Vascular Surgery clinical practice guidelines for the management of aortic aneurysms, fenestrated endovascular aortic repair is recommended as first line therapy over OSR for the management of juxtarenal abdominal aortic aneurysms.3 Initially designed for those considered unfit for open surgical repair, some specialized centers have transitioned to utilizing fenestrated and branched endovascular aortic repair (FB-EVAR) as first-line therapy for complex abdominal and thoracoabdominal aortic aneurysms.4