CIRSE Annual Congress

September 14-18 | Lisbon, Portugal

Patient centered - Science driven

September 14-18 | Lisbon, Portugal

Patient centered - Science driven

September 14-18 | Lisbon, Portugal

September 14-18 | Lisbon, Portugal

September 14-18 | Lisbon, Portugal

Patient centered - Science driven
ProgrammeSneak peeksPhysician-modified devices for complex AAA

Physician-modified devices are a robust option for treating complex aortic aneurysms

Three reasons why you cannot miss my lecture

  1. Customisation and precision: PMEGs offer a highly customisable solution that can be tailored to the specific anatomical needs of each patient, improving the precision and effectiveness of aortic endografting.
  2. Clinical outcomes: The use of PMEGs can achieve excellent clinical outcomes, particularly in complex cases where standard endografts may not provide an optimal solution. Advances in imaging and computational modelling are key to this success.
  3. Innovation and challenges: The development of PMEGs highlights innovative approaches to overcome clinical challenges. However, it also highlights the importance of addressing the technical, regulatory and ethical considerations associated with custom device modifications.
    These lessons underscore the importance of physician-modified devices in advancing patient care in vascular surgery, emphasising innovation, precision and the challenges associated with pioneering medical treatments.

Prof. Alexander Zimmermann
Speaker bio 

Add this session to your calendar!

In the evolving landscape of endovascular techniques, innovation and adaptation of endovascular procedures have significantly improved outcomes for patients with complex aortic aneurysms. One of the key advances in this field has been the development and use of physician-modified endovascular grafts (PMEGs) for aortic endografting. This presentation will explore the field of PMEGs, highlighting their robustness as a treatment option and how they are paving the way for tailored therapies in aortic endovascular therapy.

The genesis of physician-modified devices

Physician-modified devices emerged as a solution to the limitations faced by physicians in the treatment of urgent or emergency complex aortic aneurysms, particularly those involving vital side branches. By modifying commercially available endografts, physicians can create fenestrations or branches to accommodate these arteries. This presentation traces the history of PMEGs from their conceptualisation to their current status as a robust option.

Clinical results and advances

A significant portion of the lecture will be devoted to reviewing the clinical outcomes associated with the use of PMEGs. Studies have shown that PMEGs can achieve comparable success rates to off-the-shelf or custom-made devices, particularly in patients with anatomically challenging aortic aneurysms. In addition, advances in imaging techniques and computational modelling have increased the precision with which these devices can be modified, further improving patient outcomes.

Challenges and ethical considerations

Despite the promising benefits of PMEGs, their use is not without challenges. This presentation will address the technical complexities involved in modifying endografts, the steep learning curve for physicians, and the regulatory and ethical considerations associated with the use of non-standard, physician-modified devices. It also touches on the ongoing debate within the medical community regarding the balance between innovation and patient safety.

The future of physician-modified devices

Looking to the future, the presentation explores the potential for further innovation in the design and use of PMEGs. With the advent of new materials, 3D printing technology and artificial intelligence, there is a promising horizon for even more personalised and effective solutions for aortic endografting. The role of collaborative research and multidisciplinary teams is emphasised as crucial for the advancement of this field.


Physician-modified devices represent a significant leap forward in the treatment of complex aortic aneurysms. By offering a personalised solution, PMEGs have the potential to improve outcomes for patients who may otherwise face significant risks or lack appropriate treatment options. As the field continues to evolve, continued refinement of these devices and techniques promises to further enhance their efficacy and applicability.


Alexander Zimmermann

Universitätsspital Zürich, Zurich/CH

Prof. Zimmermann studied medicine at the Ludwig Maximilian University of Munich, the University of North Carolina (USA) and the Technical University of Munich until 2000. He completed his clinical training at the Klinikum rechts der Isar in the Department of Surgery, the Department of Plastic and Reconstructive Surgery and the Department of Vascular and Endovascular Surgery. He was board certified in vascular surgery in 2008 and has since worked as a senior physician at the Department of Vascular and Endovascular Surgery at the Technical University of Munich. He subsequently gained additional qualifications as a Phlebologist, Fellow European Board of Vascular Surgery (FEBVS), Endovascular Surgeon and Specialist, Medical Quality Management and a Master of Health Business Administration (MHBA). In 2012 he was appointed Managing Senior Physician and in 2015 Senior Consultant and Deputy Director of the Department of Vascular and Endovascular Surgery at the Technical University of Munich. This included the management of the Munich Aortic Centre. In April 2019, he was appointed Chair of Vascular Surgery at the University of Zurich and the associated management of the newly created Department of Vascular Surgery at the University Hospital Zurich.



  1. Tsilimparis N, Heidemann F, Rohlffs F, et al. Outcome of Surgeon-Modified Fenestrated/Branched Stent-Grafts for Symptomatic Complex Aortic Pathologies or Contained Rupture. J Endovasc Ther. 2017;24(6):825-832.
  2. Tachida A, Stafforini N, Singh N, Starnes B, Zettervall SL. Reinterventions after physician-modified endovascular grafts for treatment of juxtarenal aortic aneurysms are non-detrimental to long-term survival. J Vasc Surg. 2023;77(5):1367-1374.
  3. Oderich GS, Mendes BC, Correa MP. Preloaded guidewires to facilitate endovascular repair of thoracoabdominal aortic aneurysm using a physician-modified branched stent graft. J Vasc Surg. 2014;59(4):1168-1173.
  4. Karaolanis GI, Papazoglou DD, Donas KP, Helfenstein F, Kotelis D, Makaloski V. Physician-modified versus chimney endografting for pararenal aortic aneurysms: a systematic review and meta-analysis. J Cardiovasc Surg (Torino). Published online April 18, 2024.
  5. Juszczak MT, Vezzosi M, Khan M, Mascaro J, Claridge M, Adam D. Endovascular repair of acute juxtarenal and thoracoabdominal aortic aneurysms with surgeon-modified fenestrated endografts. J Vasc Surg. 2020;72(2):435-444.
  6. Jayet J, Canonge J, Heim F, Coggia M, Chakfé N, Coscas R. Mechanical Comparison between Fenestrated Endograft and Physician-Made Fenestrations. J Clin Med. 2023;12(15).