Fenestrated endovascular aneurysm repair.

Area of Science:

• Vascular Surgery
• Endovascular Techniques
• Aortic Aneurysm Repair

Background:

• Fenestrated endovascular aneurysm repair (FEVAR) is a complex procedure with potential risks including limb ischemia and contrast-induced nephropathy.
• The benefits of FEVAR compared to open repair may be less pronounced than standard EVAR.
• This meta-analysis examines existing observational data on FEVAR to address current evidence gaps.

Purpose of the Study:

• To conduct a meta-analysis of observational studies on FEVAR for juxtarenal abdominal aortic aneurysms.
• To highlight current issues and limitations in the evidence base for FEVAR.
• To assess the potential benefits of FEVAR in comparison to open repair.

Main Methods:

• A systematic search identified studies reporting FEVAR for juxtarenal abdominal aortic aneurysms.
• Studies with fewer than ten procedures, those predominantly using branched endografts, or for aortic dissection were excluded.
• Efforts were made to contact authors to prevent patient data duplication.

Main Results:

• Eleven studies encompassing 660 FEVAR procedures were included.
• Variability in aneurysm morphology definitions and inclusion/exclusion criteria was noted.
• Reported 30-day mortality was 2.0% (11 deaths), with poorly documented morbidity and target vessel perfusion rates between 90.5-100%.

Conclusions:

• FEVAR is a feasible alternative for repairing suprarenal and juxtarenal aneurysms.
• There is a lack of Level 1 evidence supporting FEVAR.
• Significant questions remain unanswered, and the current evidence base for FEVAR is considered weak.