Fenestrated endografts: are they the solution for visceral and aortic neck issues?

Many patients with short neck or no neck juxtarenal abdominal aortic aneurysms are not candidates for open surgical repair. Current treatment options for such patients include fenestrated endograft repair, placement of chimneys and snorkels (parallel grafts) or use of physician modified endografts. The purpose of this review is to examine the reported literature on the use of fenestrated aortic endografts for juxtarenal aortic aneurysms. A systematic review of the literature, to include clinical trials, case series, and meta-analyses was performed to report the outcomes of the use of fenestrated endovascular repair. The early and midterm results of fenestrated endografting is quite promising. As expected with real world use of the device, many patients do not meet the inclusion criteria of the initial pivotal clinical trials. As such, the results are not as good with respect to morbidity, re-intervention, and device related problems. However, despite such issues, in this difficult to treat population the initial and mid-term results as outlined below are quite acceptable. Fenestrated endografts will continue to gain acceptance and will become the treatment of choice for juxtarenal abdominal aortic aneurysms in the future.