[Fenestrated and branched endovascular aortic prostheses : An update]

Area of Science:

• Vascular Surgery
• Endovascular Repair
• Aortic Aneurysm Treatment

Background:

• Complex abdominal aortic pathologies involving visceral arteries can be treated with fenestrated/branched endovascular aortic repair (FEVAR/BEVAR).
• FEVAR/BEVAR demonstrates similar safety and success rates compared to tubular endovascular aortic repair (EVAR) for infrarenal aortic pathologies.
• These advanced techniques address cases lacking an adequate proximal neck for standard repair.

Purpose of the Study:

• To review the application and challenges of FEVAR/BEVAR for complex aortic pathologies.
• To highlight innovations in fenestrated and branched endoprostheses.
• To emphasize the critical role and potential complications of bridging stent grafts.

Main Methods:

• Discussion of fenestrations and branches for visceral artery revascularization.
• Use of bridging stent grafts to connect to target vessels.
• Availability and limitations of off-the-shelf versus custom-made endoprostheses.

Main Results:

• Patient-specific custom-made devices require significant delivery time, limiting acute treatment options.
• Off-the-shelf stent grafts with four branches offer potential for acute treatment in thoracoabdominal aneurysms.
• All FEVAR and BEVAR main bodies necessitate bridging stent grafts, currently used off-label.

Conclusions:

• Bridging stent grafts are a primary cause of reinterventions in FEVAR/BEVAR.
• Awareness of bridging stent graft fractures and kinking during follow-up is essential.
• Avoidance of single-layered bridging stent grafts in BEVAR is recommended to improve long-term outcomes.