Endovascular aortic treatment involving all aortic segments has replaced open surgery in most patients during the last three decades. Although the endovascular techniques have significantly decreased invasiveness, preoperative mortality, and morbidity, the risk of spinal cord ischemia (SCI) and stroke remains the main concern after complex endovascular aortic repair. Moreover, ensuring adequate patient selection for endovascular aortic repair and challenges related to visceral stent patency after branched endovascular aneurysm repair (BEVAR) are addressed in this thesis too.

This thesis comprises four parts. The first consisted of all patients from two high-level aortic centers who were treated with custom-made devices (CMDs) for different aortic arch pathology, with stroke as the primary endpoint. In the second part, we analyzed the safety and outcome after preoperative coil embolization of segmental arteries prior to open or endovascular aortic repair concerning the risk for SCI in a single-center observational study and a part of a meta-analysis. The third part was a multicentre international study analyzing the risks for bridging stent occlusion after BEVAR regarding the characteristics of the target vessel and bridging stents. In the fourth part, an international multicentre study tested a previously established prognostic survival model of patients treated with EVAR, using age, estimated glomerular filtration rate (eGFR), and chronic obstructive pulmonary disease (COPD) as independent predictors for survival for abdominal aortic aneurysm (AAA).

Endovascular treatment of different pathology in all aortic segments requires meticulous planning and treatment, especially in the aortic arch. The latest technical developments have made this safe. However, these expensive methods should be offered to patients with fair outcomes. Therefore, predictive models for decision-making are essential.