Beyond the instructions for use: pushing the limits of infrarenal device application for abdominal aortic aneurysms

Endograft devices are used to treat 40% to 80% of patients with abdominal aortic aneurysms. A much smaller percentage of patients have ideal anatomy, for which the devices were designed. Vascular surgeons and interventionalists have become increasingly creative in endograft placement to exclude aneurysms, despite the presence of complex aortoiliac anatomy. Arterial diameter and angulation are the most common barriers to successful endograft placement. In response to this need, graft manufacturers are increasing graft size choices, improving device flexibility, and providing improved arterial wall fixation. Despite newer devices, providers still must push the limits of defined anatomy based on the manufacturers recommended instructions to repair most infrarenal aneurysms.