Commentary: fenestrated and branched stent-grafts for the treatment of thoracoabdominal aortic aneurysms: the future is now.

摘要

It is estimated that 50% of patients with abdominal aortic aneurysms are not candidates for endovascular repair using the currently available commercial devices because of unfavorable anatomy. This includes patients with short or angulated necks or complex aneurysmal involvement of the juxtarenal, paravisceral, and thoracoabdominal aorta. Good surgical candidates may tolerate open conventional repair of the aneurysm, but patients with large aneurysms and poor cardiac, pulmonary, or renal performance have limited options. Debranching or "hybrid" operations have been used selectively in some of these patients to render the anatomy suitable for endovascular repair, but the open component of this procedure carries substantial morbidity and mortality in higher risk patients.