Since the first published report of a fenestrated endovascular aneurysm repair, we have seen an expansion in the range of custom-made devices used to manage complex aortic aneurysms. Fenestrated devices, branched devices, and chimneys are now frequently used in many centers to repair these aneurysms. Similar to standard endovascular aneurysm repair, the advantages of less operative blood loss, decreased hospital stay, and reduced risk of morbidity and mortality hold true for endovascular repair of complex aneurysms as well. This is contrasted by the requirement for long-term surveillance and increased incidence of secondary interventions.