Fenestrated and Branched Endografts

Multiple clinical trials have established the safety and efficacy of endovascular aortic aneurysm repair, which has resulted in a major paradigm shift from open to endovascular repair for the treatment of most aortic aneurysms. However, juxtarenal aneurysms (JRAAs) and more complex aneurysms involving the visceral aorta pose a significant challenge to the goals of fixation and seal using standard infrarenal devices. The need for branch vessel preservation and the individual variability of their origins from the aorta add significant complexity to the design, manufacturing, and implantation of endovascular grafts. To address these limitations, fenestrated and branched endografts have been developed that allow fixation and seal above the renal or visceral vessels but maintain perfusion to these branches by aligning fenestrations in the endograft fabric to the origins of these vessels or, in the case of thoracoabdominal aneurysms, providing branches. This review discusses fenestrated and branched endografts, as well as their complications and outcomes. Figures show definitions and examples of complex abdominal aortic aneurysm (AAA), features of the Zenith Fenestrated AAA Endovascular