Choice of optimal bridging stent and methods of visceral vessel incorporation during fenestrated/branched endovascular aortic repair for thoracoabdominal and complex abdominal aortic aneurysms

Techniques for endovascular repair of thoracoabdominal and complex abdominal aortic aneurysms have evolved in the last few decades, elucidating the variable facets for optimal bridging stent selection for visceral vessel incorporation. One must consider different stent-graft types with their relative strengths and weaknesses before implantation in target vessels. Target anatomic criteria, such as vessel diameters, tortuosity, and the presence of an early bifurcation, should also play a role in decision making. Renal arteries require special consideration, as they are associated with higher target-vessel event rates compared with the mesenteric targets. Although the overall reintervention rates after fenestrated and branched endovascular aortic repair approach nearly 20%, the technical success and target vessel patency rates remain encouragingly high at approximately 95%. More long-term outcomes studies are needed for optimization of aortic stent-graft design in the treatment of these complex aortic aneurysms.