title: Who should do endovascular repair of complex aortic aneurysms and how should they do them?
abstract: BACKGROUND
  Cure of aneurysms which involve the aorta at the level of the visceral arteries and the thoracoabdominal segment remains a considerable surgical enterprise with a relatively high mortality and morbidity despite improvements of the surgical procedure and anesthetic technique. Fenestrated and branched endovascular stent grafts are currently available offering an attractive less invasive option especially for most frail patients. These grafts are relatively recent, technically more demanding to insert than the current stent graft for infrarenal aneurysm and besides, given the relative low frequency of the disease, they are much less used by practitioners. Thus, unconditional widespread of this sophisticated technique may not necessarily benefit patients.
  
  
  METHODS
  We reviewed our experiences and articles regarding this concern, 1) who should perform this new technique and 2) in what kind of setting.
  
  
  CONCLUSIONS
  Based on the combined complexities of 1) patients selection, 2) proper planning and manufacturing of the graft, 3) the need for outstanding imaging and operating facilities, 4) and the required endovascular skill of physicians involved in the procedure, we feel that only highly specialized centers should be allowed to perform this complex procedure.
authors.affiliation: Department of Vascular Surgery, Nagoya University Hospital, Nagoya, Japan. Electronic address: hbanno@med.nagoya-u.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Banno
authors.affiliation: Department of Vascular Surgery, Henri Mondor Hospital, Creteil, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Marzelle
authors.affiliation: Department of Vascular Surgery, Henri Mondor Hospital, Creteil, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Becquemin
mesh_terms: D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D014057:Tomography, X-Ray Computed
keywords: Branched; Branched endovascular aortic repair (BEVAR); Complex aortic aneurysm; Endovascular aortic repair; Fenestrated; Fenestrated endovascular aortic repair (FEVAR)