Sveinsson M, Sonesson B, Dias N, et al. - Given the limitations encountered with performing fenestrated endovascular aneurysm repair (FEVAR) with custom made devices (CMDs) for complex abdominal aortic aneurysms (AAAs) in both the emergency and elective settings due to time consuming manufacture, and “Off the shelf” (OTS) fenestrated stent grafts to be a potential solution, researchers here evaluated the 5 year outcome of the COOK Zenith p-Branch OTS device at a single center. They performed a prospective, non-randomized, non-comparative trial enrolling patients with juxtarenal AAA meeting the inclusion criteria for the COOK Zenith p-Branch device. Of 23 patients receiving treatment, 21 completed follow up. Outcomes support the safety of performing FEVAR with the COOK Zenith p-Branch device and suggest its effectiveness for juxtarenal AAA in a selected patient population, in both elective and emergency settings. Although inferior to CMDs, acceptable long term outcomes are reported. Based on mid and long term outcomes, they emphasize the p-Branch to be a possible endovascular treatment for juxtarenal aortic pathology where CMD is not an option.