Fenestrated grafts or debranching procedures for complex abdominal aortic aneurysms

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortic Aneurysm Treatment

Background:

• Endovascular Aneurysm Repair (EVAR) is standard for infrarenal abdominal aortic aneurysms.
• 30-40% of patients are ineligible for standard EVAR due to unfavorable anatomy, particularly the proximal aortic neck.
• Open repair of pararenal/suprarenal aneurysms has improved but remains poorly tolerated by many.

Purpose of the Study:

• To review and analyze outcomes of alternative techniques for complex aortic aneurysms.
• To explore fenestrated devices as a treatment option.
• To evaluate visceral artery debranching with endovascular grafting for challenging cases.

Main Methods:

• Review of multiple clinical series.
• Analysis of outcomes for fenestrated endovascular repair.
• Analysis of outcomes for visceral artery debranching followed by endovascular grafting.

Main Results:

• Fenestrated devices and visceral artery debranching are viable alternatives for complex aortic aneurysms.
• These techniques address anatomical limitations of standard EVAR.
• Outcomes from reviewed series demonstrate the effectiveness of these advanced methods.

Conclusions:

• Fenestrated devices and visceral artery debranching expand endovascular treatment options for complex pararenal, juxtarenal, and thoracoabdominal aneurysms.
• These methods provide alternatives for patients unsuitable for open repair.
• Further analysis of outcomes supports the use of these advanced EVAR techniques.