Historical Evolution of Physician-Modified Endografts (PMEGs) for Treatment of Complex Aortic Aneurysms

Physician-modified endovascular grafts (PMEGs) were introduced as an alternative to company manufactured off-the-shelf or patient-specific fenestrated-branched stent-grafts primarily to treat high-risk patients with symptomatic, rapidly enlarging, or ruptured complex aortic aneurysms. Although these devices were created to fill a gap of clinical need in centers without access to commercially available devices, PMEGs are currently part of the armamentarium of most centers treating patients with complex aortic aneurysms and, in some cases, are better suited than an off-the-shelf device to optimize design and aortic coverage to the needs of the patient. The clinical experience of early adopters has expanded to large multicenter experiences over the last 2 decades. This article summarizes the historical evolution and current state of art of PMEGs to treat complex aortic aneurysms.