Modern management of aortic aneurysms using physician-modified endografts

Fenestrated, branched endovascular abdominal aortic repair (FBEVAR) has been widely adopted as a minimally invasive treatment option for complex abdominal and thoracoabdominal aortic aneurysms with excellent outcomes, with most reports utilizing custom manufactured or off-the-shelf FBEVAR devices. Physician-modified endograft (PMEG) has emerged as a useful alternative to manufactured devices. Currently, there is no standard approach for the preparation and implementation of PMEGs. In this article, we review the considerations for planning, modification and implantation techniques of PMEG, as well as discuss the emerging data on its safety and efficacy. The role and indications of PMEG are likely to shift as dedicated manufactured devices become more widely available for complex abdominal and thoracoabdominal aortic pathologies.