Off-the-shelf options for juxtarenal and pararenal aortic aneurysm

In patients unsuitable for standard, infrarenal endovascular aneurysm repair (EVAR) due to an inadequate or inappropriate infrarenal neck, various options have been proposed to achieve a suitable endovascular repair. The primary objective in this setting is to move the endograft sealing zone to a healthier, more cranial segment of the aorta. The need for a solution for problematic proximal neck anatomy in an urgent fashion, can be heightened in the setting of extremely large or symptomatic aneurysms. Chimney techniques and physician modified stent-grafts are transitional techniques utilizing standard endovascular inventory to treat complex aneurysms. However, development of off-the-shelf stent-grafts to accommodate for the majority off pararenal aneurysms is rapidly increasing and the initial clinical experience is promising.