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Dick F., Greenhalgh R. M.
Division of Surgery, Oncology Reproductive Biology Imperial College, London, UK Vascular Surgery Research Group Charing Cross Hospital, London, UK
The vast majority of endovascular procedures of abdominal aortic aneurysm repair can be performed with modular, bifurcated, self-expanding and fully stented endografts. A recent chapter in this year’s Charing Cross Symposium Companion Book, highlighted a potential role of aorto-uni-femoral balloon-expandable stent-grafts for a certain subgroup of patients. The authors claimed that this “one-size-fits-most” stent-graft offered a versatile and minimally invasive solution to a variety of problematic situations including emergency aortic repair and adverse anatomic configurations of the aortic neck or the iliac system. The proposed technique and the available evidence were here reviewed. Only small case series have been reported using this endograft, and all evidence is observational. The claimed advantage to facilitate endovascular treatment in challenging cases must clearly be weighed against characteristic limitations of this approach, which include the need for occlusion of both the contralateral common iliac artery and the ipsilateral internal iliac artery, as well as the need for a surgical distal anastomosis with adjunctive femoro-femoral bypass surgery out of the same inguinal access. Given the wide array of current endovascular alternatives to deal with complex aortic neck anatomy in elective situations, this approach potentially has a role in emergency situations, but less so in elective situations. In any case, results from larger series and well-conducted trials need to be awaited.