ABSTRACT
Endovascular repair of aortic aneurysms has been limited to patients whose anatomy provides
a favorable fit for the available endografts. Until recently patients with short (less than 15 mm)
or conical infrarenal aortic necks, aneurysms encroaching on the visceral segment from above
or below, or involving the distal aortic arch have been deemed not amenable to endovascular
repair because the seal zone could not provide adequate substrate for a durable repair.
Although some of these patients can be treated with an open surgical procedure at an
acceptable risk using an infrarenal clamp, many require suprarenal clamping, circulatory
arrest or a staged procedure with the inherent increased risks (1-3). Furthermore, patients
deemed high risk for open surgery andwith unfavorable anatomy for endovascular surgery are
often relegated to medical management (4,5). Fenestrated and branched stent grafts designed to
accommodate tributary arteries allow for placement of the sealing stent into a greater extent of
the aorta (Fig. 1A,B) (6-8). The development of these devices has expanded the indications for
endovascular repair of aneurysmal disease (Fig. 2) (9,10).
