Update in the use of branched and fenestrated endografts to treat aortic aneurysms.

Endovascular aneurysm repair is now the preferred method of abdominal and thoracic aneurysm repair. Until recently, the limitation with this technology has been preservation of the visceral vasculature, hypogastric arteries, and the great vessels. The Zenith® Fenestrated (Cook, Bloomington, IN) is the first device available for use in the US for treatment of para-renal or juxta-renal aneurysms. A multitude of new devices are now being investigated for use in the US to treat complex aneurysm morphology. Many of these devices are already being used internationally. Cook Medical has developed three additional devices designed to treat visceral segment aneurysms and to maintain hypogastric patency. Most notable is the Zenith® t-Branch™, which is capable of treating thoracoabdominal aortic aneurysms. Gore Medical (Flagstaff, AZ), has also developed two new devices, a thoracic branch device to maintain left subclavian artery patency and an iliac branch device. Medtronic (Minneapolis, MN) has also developed a thoracic branch device. Kawasumi laboratories (Tokyo, Japan) have also pioneered an endograft capable of treating aortic arch aneurysms. The feasibility of treating aneurysms along the entire aortic length is rapidly becoming a reality. Preliminary data on these new devices demonstrate excellent technical success with acceptable morbidity and mortality rates.