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Visceral debranching to facilitate repair of complex thoracic and thoracoabdominal aneurysms.

The availability of thoracic and abdominal endografts has decreased the morbidity and mortality associated with the repair of aneurysms of the aorta. The current limitations of endografts for aneurysms involve adequate proximal and distal landing zones. Branches that are not critical, such as the internal iliac or left subclavian artery, may often be covered and included in the landing zone for most patients, with a few exceptions. However, aneurysms involving critical branch vessels to the brain and intra-abdominal viscera cannot be covered and open repair of aneurysms in these locations carry the highest morbidity and mortality. This review describes the various techniques to relocate these critical branch vessels to expand the use of stent grafts for the treatment of these complex aneurysms.