Fenestrations and branches in the complex treatment of abdominal aortic aneurysm

Endovascular treatment with fenestrated endografts (FEVAR) using reinforced nitinol ring fenestrations are the first-line endovascular option for juxta and pararenal abdominal aortic aneurysm. The principle of the procedure is to extend the sealing zone while preserving the perfusion of collaterals. Both the perfusion and the seal are permitted with covered stent grafts. The standard use of FEVAR is however limited by significant manufacturing delays, anatomic standards and procedure’s cost. Physician-modified Endo-graft (PMEG) and in situ fenestration (ISF) have emerged to circumvent the restrictions raised by FEVAR. Both techniques lacks standardization. Indeed, several surgical teams have reported various technical details to create PMEG and ISF.
To conclude, most of the aneurysm can, nowadays, be treated by endovascular means. However, custom made endografts remain the “gold standard”.