Endovascular Repair of Complex Aortic Pathology

Aortic aneurysms are classified as complex based on their extent and involvement of side branches. Complex aortic aneurysms include arch, thoracoabdominal, juxtarenal and suprarenal aortic aneurysms. Open surgical repair carries high morbidity and mortality beyond large tertiary care centers. During the last decade, numerous technological advances have allowed incorporation of side branches using hybrid and total endovascular techniques. Fenestrated and branched endografts have been widely applied to treat patients with complex aneurysm anatomy. Newer stent graft designs are currently under clinical investigation offering an off-the-shelf alternative to custom-made stent grafts for patients with complex aortic aneurysms. Alternatively, a number of endovascular techniques have been described including chimney, snorkel, periscope and sandwich stent grafts. This article summarizes the current status of hybrid and total endovascular techniques to repair of thoracoabdominal, juxtarenal and suprarenal aortic aneurysms.