Juxtarenal abdominal aortic aneurysms (JAAA) are defined as aneurysms that involve the infrarenal abdominal aortic segment that extends up to and sometimes includes the lower margins of the renal artery origins. Endovascular repair of JAAA with standard endografts cannot be applied since there is not a landing zone available below the renal arteries. Conventional open repair necessitates suprarenal aortic clamping, which is associated with higher morbidity and mortality rates than cases where infrarenal clamping is used. Fenestrated endovascular aneurysm repair (FEVAR) was first described in 1999 as an endoluminal treatment for patients with an inadequate infrarenal aortic neck. In the case of JAAA, fenestrations and scallops of the endograft, with or without bridging stents, permit perfusion of visceral branch vessels while extending the sealing zone into the normal visceral segment of the aorta, thus achieving a secure proximal seal.
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