Physician modified endografts in the aortic arch: History, techniques, outcomes, and considerations.

Physician-modified endografts can allow for customized endovascular repair of aortic arch pathology without the cost or lead-time of fully customized endovascular devices. In high-risk patients with emergent indications for repair, these devices may be the only type of endovascular repair that can be offered, cementing their importance and role in the treatment of aortic arch pathology. However, concerns exist regarding the limitations of designs of off-the-shelf grafts, such as long nose cones, short delivery systems, orientation and alignment in the vessel lumen, lack of oversight and outcome reporting, and re-sheathing damage. In spite of these challenges, physician-modified endografts have been applied to aortic arch pathology in emergent and elective capacities with acceptable complication rates and technical advancement.