Abstract
Since the first successful use of fenestrated endografts, nearly two decades ago,1,2 we have seen a rapid evolution of technical advances, with an expanding breadth of anatomic complexity that can be successfully treated with endovascular catheter-based treatments. Endografts designed with scallops, fenestrations, and branches allow stent grafts to be placed across visceral and arch arteries while preserving flow to the critical end organs supplied by these arteries. The days of fenestrated endografts, with one or two renal fenestrations, initially used to gain 1 or 2 cm of proximal seal zone in short-neck infrarenal aneurysms, seem a long way from where we are now, able to successfully treat aortic aneurysm disease involving the aortic arch or the entire thoracoabdominal aorta.
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