Anatomic factors to guide patient selection for fenestrated-branched endovascular aortic repair

Endovascular repair of complex abdominal and thoracoabdominal aortic aneurysms has become increasingly common, with some specialized centers using fenestrated and branched endografts as a first-line therapy, given the decreased early morbidity and mortality compared with open surgical repair. However, the long-term durability of fenestrated and branched endovascular aortic repair remains in question, given the high rate of secondary interventions. Contraindications, complications, and causes of secondary interventions after fenestrated and branched endovascular aortic repair are often related to the anatomic factors of the aorta, target arteries, and access vessels. This article provides an overview of anatomic factors that should be considered when determining eligibility, as well as designing and executing fenestrated and branched endovascular aortic repair procedures.