The Current State of Fenestrated and Branched Devices for Abdominal Aortic Aneurysm Repair

Abstract

Endovascular abdominal aortic aneurysm repair (EVAR) provides an attractive alternative to traditional open techniques. Endovascular repair is frequently limited by aortic aneurysm neck angulation, the absence of an adequate infrarenal neck, and the need for internal iliac preservation. Several devices have been created to incorporate visceral artery segments as well as preserve the internal iliac artery, thus broadening the patient population suited for endovascular repair. This article will provide a review of the current literature regarding fenestrated devices, branch devices, off-the-shelf devices, and physician-modified devices. It will also highlight the iliac branch stent grafts currently on trial for internal iliac artery preservation. Data thus far have suggested that these devices will be both a safe and effective option for anatomically challenging abdominal aortic aneurysms.

Keywords: abdominal aortic aneurysm; branched; fenestrated; interventional radiology; stent graft.

Fig. 1

The Zenith fenestrated endovascular (ZFEN) stent graft is a modular system that consists of a proximal body graft, a distal bifurcated graft, and one iliac limb. Permission for use granted by Cook Medical Incorporated, Bloomington, IN.

Fig. 2

The Endologix Ventana fenestrated system consists of two scallops for the superior mesenteric artery and celiac artery as well as two fenestrations for the renal arteries.

Fig. 3

The Zenith pivot branch device includes a scallop for the celiac artery, a strut-free fenestration for the SMAs, and two renal pivot fenestrations. Permission for use granted by Cook Medical Incorporated, Bloomington, IN.

Fig. 4

The Gore Excluder Iliac Branch Endoprosthesis allows for preservation of flow to the internal iliac artery.