Anatomical variation in the visceral aortic segment is considerable. The celiac trunk follows the classical configuration in only 50 % of cases. The SMA, typically arising approximately 1 cm distal to the celiac artery, may also originate as a celiac-mesenteric trunk, or together with the splenic artery. The renal arteries typically arise at approximately the same level as each other, and usually but not always, distal to the level of the SMA. Each kidney is supplied by a single hilar artery in as few as 55 % of cases, with accessory arteries, double hilar arteries and single arteries with precocious bifurcation being the most common variations. To take account of such individual disparity, often accentuated by aortic tortuosity and aneurysmal distortion, fenestrated stent grafts which allow for preservation of aortic side branches are by necessity custom-made on an individual patient basis.
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