Thoracoabdominal aneurysm repair is undergoing a paradigm shift. The evolution of branched and fenestrated grafts has expanded the use of endografts to the visceral aorta and the arch of the aorta and broadened the spectrum of patients who can now be considered suitable for endografting. In turn, these advances have lead to a decrease in mortality and morbidity at specialized centers and are propelling the development of a series of modular devices to facilitate wider dispersion of the technology. Preoperative case planning, advanced imaging, and technical experience are keys to successful outcomes. This review examines the current state of fenestrated and branched endografting and the workarounds that have been developed to increase the use of endovascular aortic repair (EVAR).
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