Fenestrated grafts or debranching procedures for complex abdominal aortic aneurysms

Over the past 15 years, endovascular aneurysm repair of abdominal aortic aneurysms has become widely accepted as a means of treating aneurysms located in the infrarenal portion of the aorta. It has been estimated that 30% to 40% of patients with abdominal aortic aneurysms are not candidates for endovascular repair using the current commercially available devices. The primary limitation has been unfavorable anatomy most often associated with the proximal aortic neck. Although the morbidity and mortality of open pararenal or suprarenal aneurysms has improved, many patients will not tolerate open surgery. Therefore, other techniques need to be employed. This article looks at 2 other techniques to treat complex pararenal, juxtarenal, or thoracoabdominal aneurysms, one being the use of fenestrated devices and the other being visceral artery debranching followed by endovascular grafting. Multiple series are reviewed, and the outcomes are analyzed.