Physician-made fenestrated endografts versus chimney grafts

• Both techniques are off label and are indicated for patients unfit for open surgery and where other therapeutic options are not available. The techniques require excellent experience in standard EVAR and renal/visceral vessel catheterisation and grafting. • Chimney graft technique can be used for more proximal thoracoabdominal aneurysms. This technique seems to be easier and faster to perform. it is safer because of the possibility of retrieving all devices in case of access failure to target vessels. With this technique, there is less exposure to X-rays. • A physician-made fenestrated graft is more suitable anatomically and has the possible advantages of long-term durability of the technique in terms of graft patency and visceral perfusion. • Combination of the two techniques can reduce the complexity of multiple fenestrations as well as the risk of the gutters' endoleaks from multiple chimney grafts.