Branched and Fenestrated Aortic Endovascular Grafts

Abstract

Endovascular repair of abdominal and descending thoracic aortic aneurysms has become the standard of care due to improvements in morbidity and mortality compared to open surgical repair. Late durability, however, remains an issue because persistent endoleaks can lead to continued aneurysm expansion and eventual rupture, sometimes years following the original repair. Branched, fenestrated, and physician-modified endografts in the thoracic arch and thoracoabdominal aorta have extended the seal zone in order to mitigate the risks of proximal and distal endoleaks. This review summarizes the current state of branched, fenestrated, and physician-modified endografts used in complex aortic pathologies.

Short-term results of fenestrated physician-modified endografts for type1a endoleak after conventional thoracic endovascular aortic repair

“…This involves deployment in either the innominate or left common carotid artery with extra-anatomic bypass of the left common carotid or left subclavian artery. 14 …”

Current state of endovascular repair of thoracoabdominal aortic aneurysms

“…Currently, the Gore Excluder Thoracoabdominal Multi-Branched Endoprosthesis (TAMBE, W.L. Gore & Associates Inc, Flagstaff, AZ) and the Cook Zenith t-Branch graft (Cook Medical, Bloomington, IN, USA) are off-the-shelf alternatives with four downgoing branches; The TAMBE device is currently being investigated in a pivotal trial at selected US centers and likely will be commercially available in the near future for anatomically suitable patients with thoracoabdominal pathology [34,36,37] [Table 1]. Experience with the Cook T-Branch is extensive outside of the USA, with encouraging results including in patients with urgent and emergent presentations [38] [Figures 3 and 4].…”