Centralization of Care for Complex Endovascular Aortic Aneurysm Repair

Endovascular technology for aortic aneurysm repair has undergone significant evolution. Vascular surgeons have worked to expand its applicability to para-visceral and thoracoabdominal aortic aneurysms. Physician-modified endografts (PMEGs) are increasing in popularity for treating complex aneurysms, particularly in patients unfit for open surgical repair. Current data indicate that short-term morbidity and mortality after PMEGs are independent of the hospital case volume. However, further studies are necessary to clarify postoperative endoleaks and longer-term consequences. From a medico-legal and financial perspective, high-volume centers have the advantage of establishing a sustainable PMEG program.