Complex Aortic Aneurysms: The Role of Custom and Off-the-Shelf Fenestrated Endografts

Complex aortic aneurysms, including thoracoabdominal, juxtarenal, and pararenal aneurysms, pose significant challenges due to their involvement with vital branch vessels. Fenestrated endografts have emerged as a promising alternative to traditional open surgery. These devices are available in two types: custom-made and off-the-shelf. Custom fenestrated endografts are tailored to individual anatomy, offering precision but requiring longer preparation times and higher costs. Off-the-shelf fenestrated endografts provide a standardized approach with shorter deployment times and lower costs but may not suit highly complex cases. The aim of this review is to assess the role of custom and off-the-shelf fenestrated endografts in treating complex aortic aneurysms, focusing on clinical outcomes, complications, cost-effectiveness, and advancements in technology. We conducted a systematic search of PubMed, Scopus, and Google Scholar for studies published between 2000 and 2024 using keywords such as "complex aortic aneurysms," "fenestrated endograft," "custom endograft," and "off-the-shelf endograft." Data on outcomes, complications, and technological advancements were extracted and analyzed. This review seeks to provide insights into the advantages and challenges of both approaches, guiding clinicians in optimizing treatment strategies for complex aortic aneurysm patients.