Advanced endografting techniques: snorkels, chimneys, periscopes, fenestrations, and branched endografts

Endovascular aneurysm repair (EVAR) has revolutionized the treatment of abdominal aortic aneurysms (AAA). Multiple randomized trials have shown EVAR to have lower rates of morbidity and mortality when compared with open surgical AAA repair in the early perioperative period. The EVAR 1 trial and DREAM studies have shown both modalities to be equivalent after 2 years (1,2). However, the 15-year EVAR 1 data reveals that after 8 years, both total mortality and aneurysm-related mortality were higher in the EVAR group than in the open repair group. After 8 years, total mortality was 53% in the EVAR group and 46% in the open repair group (P=0.048). The aneurysm-related mortality was 5% in the EVAR group and 1% in the open repair group (P=0.0064) (3). This increased mortality was attributed to long-term aneurysm sac enlargement in the EVAR group compared to the open repair group, a fact that highlights the importance of long-term patient monitoring. Nevertheless, EVAR remains a viable option for most patients with AAA