SAIMSARA Journal

Machine Generated Science • ISSN 3054-3991

Fenestrated Endovascular Aortic Repair (FEVAR): Scoping Review with ☸️SAIMSARA.

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Cardiac & Vascular Health

Issue 1, Volume 1, 2026

DOI: 10.62487/saimsara6a4f34d7

Editorial note
• Last update: 2026-04-30 12:00:57
What is this paper about
FEVAR has matured into a first-line endovascular strategy for anatomically suitable complex aortic aneurysms, delivering high technical success and low early mortality — but its real cost is lifelong surveillance and a substantial late reintervention burden. This review maps where FEVAR clearly outperforms open repair, where durability remains uncertain, and how fusion imaging, CO₂ angiography, bridging-stent choice, spinal-cord protection, and patient selection shape modern outcomes.
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Abstract: To synthesize the current evidence regarding the technical success, perioperative safety, long-term durability, and technological advancements of fenestrated endovascular aneurysm repair (FEVAR) across diverse patient populations and clinical scenarios. The review utilises 357 original studies with 240201 total participants (topic deduplicated ΣN). The mapped evidence indicates that FEVAR is a technically mature strategy for juxtarenal, pararenal, and thoracoabdominal aneurysms, with technical success commonly reported around 95–99% and perioperative mortality near 2.4% in elective cohorts, contrasted by late reintervention burdens reaching 27.6% at seven years. Recurrent topic-level signals support an early survival advantage over open surgical repair alongside a durability trade-off, with acute kidney injury reported around 20–27% and target vessel instability driven by fenestration-to-target misalignment beyond 15 degrees and unfavorable paravisceral geometry. Converging evidence across imaging fusion, carbon dioxide angiography, ultralow-iodine planning, bundled spinal cord ischemia protocols, and duplex-based surveillance suggests that procedural and surveillance refinements meaningfully attenuate radiation, contrast, and ischemic risks. Heterogeneous signals around sex-specific outcomes, octogenarian selection, salvage after failed endovascular repair, and large-diameter device behavior highlight that patient and anatomic selection remain central practical considerations. Clinically, these patterns support FEVAR as a first-line option for anatomically suitable complex aneurysms when paired with structured lifelong surveillance and contrast- and radiation-sparing workflows. Future research should prioritize prospective comparative studies of bridging stent platforms, surgeon-modified versus custom-made devices, and standardized spinal cord ischemia and surveillance protocols, ideally integrating computational and artificial intelligence-based planning to address the durability and sex-disparity gaps identified across the evidence map.

Keywords: Fenestrated endovascular aneurysm repair; Juxtarenal aortic aneurysm; Complex aortic aneurysm; Surgeon-modified FEVAR; Fusion imaging; Acute kidney injury; Open surgical repair; Type 1a endoleak; Technical success; Reintervention rates

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