The eligibility for endovascular stent-graft repair in patients with aortic pathologies is dictated by the presence of favorable vascular anatomy. The two main anatomic features predicting successful repair are the presence of adequate attachment sites for the device anchoring and the availability of the relatively normal access vessels for safe device navigation. This chapter describes some of the complex vascular anatomies, which can initially impede aortic endovascular repair, and the maneuvers to circumvent these initial obstacles, increasing the overall pool of patients eligible for endovascular repair of complex aortic diseases.
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