[Progress on in situ fenestration during thoracic endovascular aortic repair]

Endovascular aortic arch repair remains challenging due to the complicated anatomy and the involved vital branches. Off-label techniques emerged during the last decade, including endografts with parallel stents (known as Chimney, Periscope, Sandwich), surgeon-modified endografts, and various other reported techniques. In situ fenestration of standard endografts represents another off-label endovascular means to maintain perfusion to aortic side branches located in the excluded area. Its principle is based on fenestration of an endograft following its deployment inside the vascular system. As data are emerging regarding in situ fenestration, the aim of this article is to review recent progress of technical descriptions, in vitro and clinic results of in situ fenestration from the available literature.