Surgeon-Modified Fenestrated and Branched Stent Grafts

Endovascular repair of aneurysms involving the visceral and thoracoabdominal aorta and iliac arteries has become a reality with over 1,000 cases performed worldwide. Sm-FBSG for pararenal, thoracoabdominal, and aortoiliac aneurysms have emerged as a viable endovascular alternative for patients unfit for open repair in circumstances not allowing the use of customized stent grafts or suitable off-the-shelf devices. The major limitation for widespread of this technique is the fact that a time window of 1–2 h is needed to construct the graft and the fact that it is rather complex to complete when not performed routinely.Until standardized off-the-shelf devices become widely available, sm-FBSG represent the best option for patients requiring urgent and emergent repair, especially because outcome and durability of these repairs appears to be similar to that of commercially available devices.