# Physician-Modified Endografts for Complex Aortic Aneurysms in Japan: Current Status, Clinical Outcomes, and Guideline Integration

## TL;DR

Japanese physicians modify endografts for complex aortic aneurysms due to lack of commercial options, with promising mid-term outcomes and a need for standardized protocols.

## Contribution

The paper highlights the current status and outcomes of physician-modified endografts in Japan and emphasizes the need for guideline integration.

## Key findings

- Japanese series report high technical success and acceptable mid-term outcomes with PMEGs.
- Long-term durability of PMEGs remains uncertain.
- Structured training and national registries are essential for safe and standardized practice.

## Abstract

In Japan, the absence of commercially available fenestrated and/or branched endografts has necessitated widespread adoption of physician-modified endografts (PMEGs) for complex aortic aneurysms. This paper compares PMEG use in Western countries and Japan, summarizes multicenter outcome data, and highlights the gap between real-world practice and current Japanese aortic disease guidelines. Recent Japanese series report high technical success and acceptable mid-term outcomes, comparable to Western reports. While long-term durability remains uncertain, structured training, national registries, and standardized protocols are essential. Guideline acknowledgment of PMEGs could improve safety, consistency, and international alignment in complex endovascular therapy. Establishing structured training, national registries, and evidence-based policy recognition of PMEGs is essential to ensure safe and standardized practice in Japan.