Emerging Endovascular Techniques in the Management of Complex Aortic Aneurysms: A Systematic Literature Review

Abstract

This systematic review appraises the emergent endovascular procedures applied in the treatment of complex aortic aneurysms, such as fenestrated and branched endovascular repair, physician-modified endografts, parallel graft strategies and in situ fenestration. A systematic search of publications published in 2015-2025 found twelve eligible articles that distilled thoracoabdominal, juxtarenal, pararenal and post-dissection aneurysm outcomes. In all the methods, the technical success rates were very high but differences occurred in early mortality, branch patency, endoleak pattern and long-term durability. Parallel grafts provided important back-up emergency options but with the risk of gutter-related failure, whereas fenestrated and branched endografts proved the most reliable in mid-term. Physician-adapted and in situ methods offered much-needed flexibility in anatomically extreme or ruptured cases, but the evidence was limited by brief follow-up and variable protocols. Comprehensively, the results indicate high initial effectiveness and ongoing uncertainty about long-term viability, indicating the necessity of standardised reporting and multicentre data.