Aortic debranching procedures to facilitate endografting.

Since approval of the Gore TAG device in 2005, endo-grafting of isolated descending thoracic aneurysms has been a welcome replacement to open surgery by many vascular and cardiac surgeons. Obvious constraints of this new technology are seal zones relative to adjacent brachiocephalic and visceral vessels. This is particularly important with regard to the more extensive thoracoabdominal aortic aneurysms. Although branched or fenestrated stent grafts have been used for such cases, these technically advanced devices are not available for general use and, therefore, many practitioners are left with few alternatives other than standard open repair. Some centers have tinkered with various forms of extra-anatomic bypass to lengthen seal zone sites and facilitate stent graft repair. The lack of uniformity and long-term data hamper acceptance of this approach. This review attempts to cull all available information on this technique from recent case reports and series published in the literature.