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Published on: March 28, 2025
Fenestrated and branched stent grafts
Joseph J Ricotta1, Gustavo S Oderich
1Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA. ricotta.joseph@mayo.edu
Summary
Fenestrated and branched stent grafts offer new endovascular repair options for abdominal aortic aneurysms (AAAs) previously untreatable due to anatomy. These advanced devices enable treatment of the entire aorta, showing promising results compared to open surgery.
Area of Science:
- Vascular Surgery
- Endovascular Repair
- Aortic Aneurysm Treatment
Background:
- 50% of abdominal aortic aneurysm (AAA) patients lack suitable anatomy for current endovascular repair devices.
- Unfavorable anatomy includes short/angulated necks, internal iliac artery extension, or complex juxtarenal/paravisceral/thoracoabdominal aorta involvement.
- Open repair is an option for surgical candidates, but limited options exist for those with large aneurysms and poor systemic health.
Purpose of the Study:
- To review the global experience with fenestrated and branched stent grafting for complex aortic aneurysms.
- To discuss the historical development, techniques, and outcomes of these advanced endovascular devices.
- To explore the role of surgeon-modified devices in expanding treatment possibilities.
Main Methods:
- Review of historical background and technological advancements in fenestrated and branched stent grafts.
- Description of implantation techniques for treating juxtarenal, paravisceral, and thoracoabdominal aortic aneurysms.
- Summary of intermediate-term clinical results from worldwide experience.
Main Results:
- Fenestrated and branched stent grafts extend the sealing zone to the suprarenal aorta, overcoming limitations of short or absent infrarenal necks.
- These devices facilitate complete endovascular repair for extensive aortic pathologies, including pararenal, juxtarenal, and thoracoabdominal aneurysms.
- Short-term outcomes of endovascular repair with these grafts are comparable to open surgical repair.
Conclusions:
- Fenestrated and branched stent grafting represents a significant advancement, enabling endovascular treatment for a wider range of complex aortic aneurysms.
- These technologies provide a viable alternative to open surgery, particularly for patients with unfavorable anatomy or limited physiological reserve.
- Continued development and application of these devices, including surgeon-modified options, are expanding the reach of endovascular aortic repair.
