Advances in fenestrated and branch stent-graft technology and current applications in patients with complex aortic aneurysms

Infrarenal aortic aneurysms represent the simplest form of aortic aneurysmal disease. Endovascular repair of aortic aneurysms has been shown to decrease operative time, blood loss, length of hospital stay and 30-day morbidity and mortality as compared to open conventional repair. This technique is ideal in the elderly and higher risk patient, but it has been increasingly used in good risk patients. Several anatomic constraints such as inadequate proximal neck, involvement of the renal, visceral or hypogastric arteries, and presence of aortic angulation and tortuosity challenge the universal application of stent grafts to treat aortic aneurysms. Involvement of the renal and visceral arteries require higher exposure of the aorta proximal to the renal arteries and temporary supra-renal or supra-mesenteric aortic cross-clamping, which increases the complexity of the operation and carry higher risk of complications. It is logical to speculate that the advantages achieved with endovascular repair of infrarenal aneurysms will pale in comparison to the potential for reduction in morbidity and mortality for treatment of more complex aneurysms that involve the visceral segment. This article summarizes the recent advances, techniques and results of fenestrated and branched stent graft technology which allow incorporation of the renal and visceral arteries using a total endovascular approach for the treatment of complex aortic aneurysms.".