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Figure 5. Illustration representing the configuration of stents for fenestrations (alignment stents) and branches (bridging stents). The
flared segment avoids disconnection and migration of the modules, ensuring optimal alignment and stability of the components,
furthermore, facilitating catheterization by the guidewire, if needed. (Reproduced bypermission of Mayo Foundation for Medical
Education and Research. All rights reserved).

approach (2.8% vs. 1.2%; P = 0.036). Therefore, utilizing the TF approach may be a preferable option
whenever possible to minimize the risk of cerebral embolic events and stroke . Despite theoretical
[54]
concerns regarding a potential increased risk of stroke associated with right UE access compared to left UE
access, studies have shown no significant difference .
[55]

Spinal cord drainage
Spinal cord ischemia (SCI) is a devastating complication following repair of TAAAs, regardless of the type
of approach utilized, open or endovascular, and is associated with decreased quality of life and overall
survival . Several factors have been demonstrated to affect rates of spinal cord ischemia. The single most
[56]
important is the extent of aortic disease, with the highest rates observed for type II TAAAs . It is well
[20]
stablished the necessity of prevention, early identification, and treatment of SCI to prevent permanent
paraplegia, overall worse results, and decreased rates of survival . Compromised subclavian, vertebral, and
[57]
hypogastric perfusion are recognized risk factors for SCI after aortic aneurysm repair . Measures to
[58]
prevent SCI during endovascular TAAA repair focus on maneuvers to optimize spinal cord perfusion, such
as the use of spinal cord drainage (SCD), multistaged approach, and adjunctive procedures such as
temporary sac perfusion, early limb reperfusion, and augmentation of blood pressure and cellular oxygen
[56]
delivery . Currently, our institutional practice has changed to a highly careful selection of patients who