Fenestrated and branched stent-grafts are being increasingly used to address complex pararenal and thoracoabdominal aortic aneurysms by endovascular means. The present paper describes the current indications, anatomical suitability and techniques of fenestrated and branched stent-grafts in the treatment for pararenal and thoracoabdominal aortic pathologies. Published outcomes with regard to perioperative mortality and morbidity, survival, reinterventions and target vessel patency during follow-up are also presented. Finally, advantages and disadvantages of endovascular repair as compared to open repair are discussed.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T, Dick F, van Herwaarden J, Karkos C, Koelemay M, et al. Editor’s choice—European society for vascular surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8–93.
Katsargyris A, Verhoeven EL. Endovascular strategies for infrarenal aneurysms with short necks. J Cardiovasc Surg (Torino). 2013;54(1 (Suppl 1)):21–6.
Verhoeven EL, Vourliotakis G, Bos WT, Tielliu IF, Zeebregts CJ, Prins TR, Bracale UM, van den Dungen JJ. Fenestrated stent grafting for short-necked and juxtarenal abdominal aortic aneurysm: an 8-year single-centre experience. Eur J Vasc Endovasc Surg. 2010;39(5):529–36.
Ziegler P, Avgerinos ED, Umscheid T, Perdikides T, Stelter WJ. Fenestrated endografting for aortic aneurysm repair: a 7-year experience. J Endovasc Ther. 2007;14(5):609–18.
Browne TF, Hartley D, Purchas S, Rosenberg M, Van Schie G, Lawrence-Brown M. A fenestrated covered suprarenal aortic stent. Eur J Vasc Endovasc Surg. 1999;18(5):445–9.
Anderson JL, Adam DJ, Berce M, Hartley DE. Repair of thoracoabdominal aortic aneurysms with fenestrated and branched endovascular stent grafts. J Vasc Surg. 2005;42(4):600–7.
Chuter TA, Gordon RL, Reilly LM, Goodman JD, Messina LM. An endovascular system for thoracoabdominal aortic aneurysm repair. J Endovasc Ther. 2001;8(1):25–33.
Verhoeven EL, Katsargyris A, Oikonomou K, Kouvelos G, Renner H, Ritter W. Fenestrated endovascular aortic aneurysm repair as a first line treatment option to treat short necked, Juxtarenal, and suprarenal Aneurysms. Eur J Vasc Endovasc Surg. 2016;51(6):775–81.
Oikonomou K, Kasprzak P, Katsargyris A, Marques De Marino P, Pfister K, Verhoeven ELG. Mid-term results of fenestrated/branched stent grafting to treat post-dissection Thoraco-abdominal Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):102–9.
Spear R, Hertault A, Van Calster K, Settembre N, Delloye M, Azzaoui R, Sobocinski J, Fabre D, Tyrrell M, Haulon S. Complex endovascular repair of postdissection arch and thoracoabdominal aneurysms. J Vasc Surg. 2018;67(3):685–93.
Spanos K, Kolbel T, Theodorakopoulou M, Heidemann F, Rohlffs F, Debus ES, Tsilimparis N. Early outcomes of the t-branch off-the-shelf multibranched stent-graft in urgent thoracoabdominal aortic aneurysm repair. J Endovasc Ther. 2018;25(1):31–9.
Verhoeven EL, Katsargyris A, Bekkema F, Oikonomou K, Zeebregts CJ, Ritter W, Tielliu IF. Editor’s choice—10-year experience with endovascular repair of thoracoabdominal aortic aneurysms: results from 166 consecutive patients. Eur J Vasc Endovasc Surg. 2015;49(5):524–31.
Geisbusch S, Kuehnl A, Salvermoser M, Reutersberg B, Trenner M, Eckstein HH. Editor’s choice—hospital incidence, treatment, and in hospital mortality following open and endovascular surgery for Thoraco-abdominal aortic aneurysms in Germany from 2005 to 2014: secondary data analysis of the nationwide German DRG microdata. Eur J Vasc Endovasc Surg. 2019;57(4):488–98.
Moore R, Hinojosa CA, O’Neill S, Mastracci TM, Cina CS. Fenestrated endovascular grafts for juxtarenal aortic aneurysms: a step by step technical approach. Catheter Cardiovasc Interv. 2007;69(4):554–71.
Verhoeven EL, Katsargyris A, Fernandes e Fernandes R, Bracale UM, Houthoofd S, Maleux G. Practical points of attention beyond instructions for use with the Zenith fenestrated stent graft. J Vasc Surg. 2014;60(1):246–52.
Katsargyris A, Oikonomou K, Kouvelos G, Mufty H, Ritter W, Verhoeven ELG. Comparison of outcomes for double fenestrated endovascular aneurysm repair versus triple or quadruple fenestrated endovascular aneurysm repair in the treatment of complex abdominal aortic aneurysms. J Vasc Surg. 2017;66(1):29–36.
Vento V, Soler R, Fabre D, Gavit L, Majus E, Brenot P, Gargiulo M, Haulon S. Optimizing imaging and reducing radiation exposure during complex aortic endovascular procedures. J Cardiovasc Surg (Torino). 2019;60(1):41–53.
Jones DW, Stangenberg L, Swerdlow NJ, Alef M, Lo R, Shuja F, Schermerhorn ML. Image fusion and 3-dimensional ROADMAPPING in endovascular surgery. Ann Vasc Surg. 2018;52:302–11.
Oikonomou K, Katsargyris A, Brinster CJ, Renner H, Ritter W, Verhoeven EL. Retrograde target vessel catheterization as a salvage procedure in fenestrated/branched endografting. J Endovasc Ther. 2015;22(4):603–9.
Ferreira M, Katsargyris A, Rodrigues E, Ferreira D, Cunha R, Bicalho G, Oderich G, Verhoeven ELG. “Snare-ride”: a bailout technique to catheterize target vessels with unfriendly anatomy in branched endovascular aortic repair. J Endovasc Ther. 2017;24(4):556–8.
Panuccio G, Rohlffs F, Makaloski V, Eleshra A, Tsilimparis N, Kölbel T. Through-and-through suture technique to stabilize a sheath in branched endovascular aortic repair. J Endovasc Ther. 2019;26(6):805–9.
Katsargyris A, Marques de Marino P, Mufty H, Pedro LM, Fernandes R, Verhoeven ELG. Early experience with the use of inner branches in endovascular repair of complex abdominal and thoraco-abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2018;55(5):640–6.
Maurel B, Delclaux N, Sobocinski J, Hertault A, Martin-Gonzalez T, Moussa M, Spear R, Le Roux M, Azzaoui R, Tyrrell M, et al. The impact of early pelvic and lower limb reperfusion and attentive peri-operative management on the incidence of spinal cord ischemia during thoracoabdominal aortic aneurysm endovascular repair. Eur J Vasc Endovasc Surg. 2015;49(3):248–54.
Amiot S, Haulon S, Becquemin JP, Magnan PE, Lermusiaux P, Goueffic Y, Jean-Baptiste E, Cochennec F, Favre JP. Fenestrated endovascular grafting: the French multicentre experience. Eur J Vasc Endovasc Surg. 2010;39(5):537–44.
Bicknell CD, Cheshire NJ, Riga CV, Bourke P, Wolfe JH, Gibbs RG, Jenkins MP, Hamady M. Treatment of complex aneurysmal disease with fenestrated and branched stent grafts. Eur J Vasc Endovasc Surg. 2009;37(2):175–81.
Katsargyris A, Oikonomou K, Klonaris C, Topel I, Verhoeven EL. Comparison of outcomes with open, fenestrated, and chimney graft repair of juxtarenal aneurysms: are we ready for a paradigm shift? J Endovasc Ther. 2013;20(2):159–69.
Mastracci TM, Eagleton MJ, Kuramochi Y, Bathurst S, Wolski K. Twelve-year results of fenestrated endografts for juxtarenal and group IV thoracoabdominal aneurysms. J Vasc Surg. 2015;61(2):355–64.
Katsargyris A, Klonaris C, Verhoeven EL. Is volume important in aneurysm treatment outcome? J Cardiovasc Surg (Torino). 2017;58(2):187–93.
Motta F, Crowner JR, Kalbaugh CA, Marston WA, Pascarella L, McGinigle KL, Kibbe MR, Farber MA. Outcomes and complications after fenestrated-branched endovascular aortic repair. J Vasc Surg. 2019;70(1):15–22.
Oderich GS, Ribeiro M, Reis de Souza L, Hofer J, Wigham J, Cha S. Endovascular repair of thoracoabdominal aortic aneurysms using fenestrated and branched endografts. J Thorac Cardiovasc Surg. 2017;153(2):S32–41.
Kolvenbach RR, Yoshida R, Pinter L, Zhu Y, Lin F. Urgent endovascular treatment of thoraco-abdominal aneurysms using a sandwich technique and chimney grafts–a technical description. Eur J Vasc Endovasc Surg. 2011;41(1):54–60.
Ricotta JJ 2nd, Tsilimparis N. Surgeon-modified fenestrated-branched stent grafts to treat emergently ruptured and symptomatic complex aortic aneurysms in high-risk patients. J Vasc Surg. 2012;56(6):1535–42.
Konstantinou N, Antonopoulos CN, Jerkku T, Banafsche R, Kolbel T, Fiorucci B, Tsilimparis N: Systematic review and meta-analysis of published studies on endovascular repair of thoracoabdominal aortic aneurysms with the t-Branch off-the-shelf multibranched endograft. J Vasc Surg. 2020 (in press).
Mascoli C, Vezzosi M, Koutsoumpelis A, Iafrancesco M, Ranasinghe A, Clift P, Mascaro J, Claridge M, Adam DJ. Endovascular repair of acute thoraco-abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2018;55(1):92–100.
Ferrer C, Cao P, De Rango P, Tshomba Y, Verzini F, Melissano G, Coscarella C, Chiesa R. A propensity-matched comparison for endovascular and open repair of thoracoabdominal aortic aneurysms. J Vasc Surg. 2016;63(5):1201–7.
Rocha RV, Friedrich JO, Elbatarny M, Yanagawa B, Al-Omran M, Forbes TL, Lindsay TF, Ouzounian M. A systematic review and meta-analysis of early outcomes after endovascular versus open repair of thoracoabdominal aortic aneurysms. J Vasc Surg. 2018;68(6):1936–45.
Locham S, Dakour-Aridi H, Nejim B, Dhaliwal J, Alshwaily W, Malas M. Outcomes and cost of open versus endovascular repair of intact thoracoabdominal aortic aneurysm. J Vasc Surg. 2018;68(4):948–55.
Mastracci TM, Greenberg RK, Eagleton MJ, Hernandez AV. Durability of branches in branched and fenestrated endografts. J Vasc Surg. 2013;57(4):926–33 (discussion 933).
Kouchoukos NT, Kulik A, Castner C. Branch graft patency after open repair of thoracoabdominal aortic aneurysms. J Thorac Cardiovasc Surg. 2017;153(2):S14–9.
This study was not supported by any funding.
Conflict of interest
Eric LG Verhoeven has received research grants from Cook Inc. and honoraries as speaker and consultant from Cook Inc, Maquet-Getinge and Bentley InnoMed. Pablo Marques de Marino declares that has no conflict of interest. Athanasios Katsargyris has received speaker fees from Cook Inc. and is a consultant for Bentely InnoMed.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Verhoeven, E.L.G., Marques de Marino, P. & Katsargyris, A. Increasing Role of Fenestrated and Branched Endoluminal Techniques in the Thoracoabdominal Segment Including Supra- and Pararenal AAA. Cardiovasc Intervent Radiol 43, 1779–1787 (2020). https://doi.org/10.1007/s00270-020-02525-2
- Pararenal aortic aneurysm
- Thoracoabdominal aortic aneurysm
- Endovascular procedures
- Open repair