Learning curve in fenestrated and branched grafting.

In surgical practice new technologies and techniques require a period of adjustment before the main operator becomes familiar with the new procedure, improving the results and the performances. This period, called learning curve, could be applied into the endovascular aortic treatment. The CUSUM technique had been used to define the learning curve in new procedures and through the literature some studies applied it to demonstrate the improving outcomes in complex endovascular aneurysm repair during increasing experience time. However, in the complex endovascular field this period included also other factors besides the proficiency in the deployment, as the improvement in patient selection and device design, making difficult to determine the level of experience needed to become an expert.