Contemporary indications, techniques, and outcomes of physician-modified endografts for the treatment of complex abdominal and thoracoabdominal aortic aneurysms

The article describes contemporary indications, techniques, and outcomes of physician-modified endografts (PMEGs) for the treatment of complex aortic aneurysms. Physician-modified endografting has been performed with high technical success rates and lower complication rates compared with traditional open surgery for complex aortic aneurysms. Various techniques have been reported for the design, modification, and implantation of PMEGs, using different off-the-shelf devices. Although PMEGs are used more commonly for urgent and emergent repair of symptomatic or ruptured complex abdominal and thoracoabdominal aortic aneurysms in patients who do not have access to manufactured devices, some centers have reported utilization of PMEGs in elective cases under the aegis of the US Food and Drug Administration–approved Investigational Device Exemption protocols. Although the initial outcomes of PMEGs are promising, continued surveillance remains a crucial component to determine long-term durability. All treatment options for complex abdominal and thoracoabdominal aortic aneurysms should be considered carefully, with PMEGs reserved for those cases unsuitable for other repair alternatives, and at centers with the volume and expertise to execute the procedure with high technical success and low morbidity and mortality rates. With the continued evolution of endovascular technology, the role and indications for PMEGs are expected to change.