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Incidence and management of complications after branched and fenestrated endografting.

Endovascular treatment of complex aortic aneurysms with fenestrated and branched stentgrafts is in rapid development. Early and midterm results from centers of excellence are very promising but the technique is still in its infancy. With the introduction of EVAR for complex aneurysms a new set of failure modes have also been introduced. These relate both to the specific deployment techniques of the devices and to their intrinsic design characteristics. Procedural planning is of utmost importance for success. Failure to accomplish this may result in disastrous and uncorrectable perioperative failure. The endograft must be correctly tailored to the patient with regards to branch and fenestration positioning and design. Migration of stent-graft components, target vessel occlusions due to branch compression or dislocation and fenestration malpositioning must be recognized during follow up and treated accordingly. The clinical consequences of complex aneurysm repair include spinal cord ischemia and peripheral embolisation and strategies to handle this must be present.