Indications for fenestrated endovascular aneurysm repair

Area of Science:

• Vascular Surgery
• Endovascular Repair
• Medical Device Technology

Background:

• Fenestrated endovascular aneurysm repair (FEVAR) has advanced, but evidence is limited to infra-renal aortic aneurysms.
• The high cost and complexity of FEVAR make its current role uncertain.
• A national consensus model was developed to propose indications for FEVAR.

Purpose of the Study:

• To establish a consensus on the appropriate indications for fenestrated endovascular aneurysm repair (FEVAR).
• To address the unclear role of FEVAR in current clinical practice.
• To inform guidelines for FEVAR use.

Main Methods:

• Utilized the RAND appropriateness methodology across UK FEVAR and high-volume aneurysm treatment centers.
• Included a meta-analysis of current literature and a survey of UK practice.
• Conducted two rounds of consensus meetings, including online case vignette surveys and a nominal group meeting.

Main Results:

• Over 90% of UK FEVAR centers participated in the consensus process.
• Literature review revealed heterogeneous case series without clear FEVAR indications.
• Consensus on FEVAR indications was achieved in 68.8% of cases, particularly for moderate-risk open repair scenarios and suprarenal clamping needs. Indications were less clear for elderly patients or specific aneurysm morphologies.

Conclusions:

• The study identified areas of agreement and equipoise regarding FEVAR indications.
• These findings provide a basis for developing guidelines to inform clinicians, commissioners, and health economists.
• The consensus model helps clarify the appropriate use of FEVAR in complex aortic aneurysm repair.