In the 9 years since the technique was first described, multi-branched stent-grafts have been used to treat hundreds of aneurysms in the aortic arch, thoracoabdominal aorta, and common iliac artery. Although the addition of a single renal side branch to a stent-graft is hardly novel, the case presented by Bertoni et al. has several unusual features: the stent-graft was balloon-expanded, the graft fabric was weft knitted polyester, the attachment site was short and oriented in a radial (transaxial) direction relative to the long axis of the stent-graft, and the stent-graft had a single iliac outflow. Most of these features have been tried before in a variety of other applications, and published clinical experience provides scant support for the assertions of superior performance expressed in the discussion of Bertoni's article.
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