The Current State of Physician-Modified Endovascular Grafts in Complex Abdominal Aortic Aneurysms

Physician-modified endografts (PMEGs) for the treatment of complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms are a viable option. Other endovascular options include custom and off-the-shelf devices for fenestrated and branched endovascular aortic repair, parallel grafts, and in situ laser fenestration. The limitations of these devices include time to development, strict anatomic criteria, and durability regarding parallel grafts. PMEGs fill this void with perioperative and long-term outcomes similar to custom-made devices. Postdissection aneurysms also present a unique role for PMEGs given the added complexity with fixing these aneurysms and have been reported with good outcomes. Lastly, we discuss the approach to preoperative planning and the operative component of PMEGs in this brief review.