Branched and Fenestrated Endografts: Technology, Planning Process and Implantation Technique

Successful endovascular repair of abdominal aortic aneurysms (AAA) requires undilated proximal (infrarenal neck) and distal landing zones (common or external iliac arteries). A range of approved endografts are available to exclude such aneurysms. Recent multicentric prospective randomized trials have demonstrated a short and midterm decrease in aneurysmrelated deaths of the endovascular technique compared to open surgery [1-4]. These results have induced an overall increase in the rate of endovascular repair of AAA. Patients with more complex aortic aneurysms, involving the visceral vessels (juxta, para and thoracoabdominal aneurysms) or both common iliac arteries, have an increased peri-operative morbidity and mortality after open repair compared to AAA [5,6]. These patients could potentially benefit from an endovascular approach. Branched and fenestrated endografts have been developed to address this endovascular challenge [7-14]. The chapter written by Roy Greenberg et al. will focus on the data already available to evaluate these new endovascular procedures. We will describe the available technology, the planning process and the implantation technique.