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2018 ; 8
(Suppl 1
): S175-S183
Nephropedia Template TP
Kansagra K
; Kang J
; Taon MC
; Ganguli S
; Gandhi R
; Vatakencherry G
; Lam C
Cardiovasc Diagn Ther
2018[Apr]; 8
(Suppl 1
): S175-S183
PMID29850429
show ga
The anatomy of aortic aneurysms from the proximal neck to the access vessels may
create technical challenges for endovascular repair. Upwards of 30% of patients
with abdominal aortic aneurysms (AAA) have unsuitable proximal neck morphology
for endovascular repair. Anatomies considered unsuitable for conventional
infrarenal stent grafting include short or absent necks, angulated necks, conical
necks, or large necks exceeding size availability for current stent grafts. A
number of advanced endovascular techniques and devices have been developed to
circumvent these challenges, each with unique advantages and disadvantages. These
include snorkeling procedures such as chimneys, periscopes, and sandwich
techniques; "homemade" or "back-table" fenestrated endografts as well as
manufactured, customized fenestrated endografts; and more recently, physician
modified branched devices. Furthermore, new devices in the pipeline under
investigation, such as "off-the-shelf" fenestrated stent grafts, branched stent
grafts, lower profile devices, and novel sealing designs, have the potential of
solving many of the aforementioned problems. The treatment of aortic aneurysms
continues to evolve, further expanding the population of patients that can be
treated with an endovascular approach. As the technology grows so do the number
of challenging aortic anatomies that endovascular specialists take on, further
pushing the envelope in the arena of aortic repair.