Large, single-center databases and the evolution of endovascular therapy for complex aortic aneurysms

Abstract

Fenestrated and branched endograft repair of complex aortic disease has revolutionized the approach to treatment of this life-threatening problem. Several sites have developed long-standing programs evaluating the application and outcomes of this technology. These reports are based on the development of large, single-center databases. These centers have helped to pioneer the evolution of this approach, and their assessments have led to significant improvements and identified areas that require improvement in the ensuing years. Four main centers that are known to have developed large, single-center databases were identified. A literature review was performed to collect the contributions that were made on the topic of fenestrated/branched endograft repair of complex aortic aneurysms were selected and reviewed. Nearly a decade and a half of progress has been made in developing endovascular treatment of complex aortic disease. The application of this technology has been limited in the United States due to its investigational nature, but has achieved commercialization in Europe. These centers that have accrued large numbers of patients and have defined the initial expected perioperative outcomes. In addition, they have identified areas of high risk for these patients including perioperative renal failure and the development of spinal cord ischemia. Long-term outcomes are being developed with a special interest in evaluating branch patency, renal function, and device and aortic durability. Endovascular approaches to treat complex aortic disease, while more than a decade old, are still in the early phases of its wide-spread application. Improvements in device design will occur throughout the next several years, which will ease the placement of these devices and improve perioperative and long-term outcomes.