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.
Final search date and database lock: 2026-04-28 16:06:20 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 604
Downloaded Abstracts/Papers: 604
Included original and non-original Abstracts/Papers (all): 398
Included original Abstracts/Papers (Vote counting by direction of effect): 357
Reference Index (links used in paper): 209
Total participants (topic deduplicated ΣN): 240201
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Reference Index (209)
[1] Midterm results after FEVAR and open surgery for infrarenal aortic aneurysms with short proximal necks: systematic review with meta-analysis of comparative studies. — https://doi.org/10.23736/s0392-9590.24.05283-0
[5] Systematic review with pooled data analysis reveals the need for a standardized reporting protocol including the visceral vessels during fenestrated endovascular aortic repair (FEVAR). — https://doi.org/10.1177/17085381211019148
[6] Patient-specific computational flow modelling for assessing hemodynamic changes following fenestrated endovascular aneurysm repair. — https://doi.org/10.1016/j.jvssci.2020.11.032
[9] Early and Mid-Term Durability of Surgeon-Modified and Custom-Made Fenestrated Devices for the Treatment of Complex Aortic Pathology. — https://doi.org/10.1016/j.avsg.2021.12.006
[16] Comparison of outcomes for double fenestrated endovascular aneurysm repair versus triple or quadruple fenestrated endovascular aneurysm repair in the treatment of complex abdominal aortic aneurysms. — https://doi.org/10.1016/j.jvs.2016.11.043
[19] Comparative Effectiveness of Treatment Modalities for Complex Aortic Aneurysms: A Network Meta-Analysis of Observational Studies. — https://doi.org/10.1016/j.avsg.2023.02.023
[26] Introduction of a Team Based Approach to Radiation Dose Reduction in the Enhancement of the Overall Radiation Safety Profile of FEVAR. — https://doi.org/10.1016/j.ejvs.2016.05.010
[27] Chimney Versus Fenestrated Endovascular Versus Open Repair for Juxta/Pararenal Abdominal Aortic Aneurysms: Systematic Review and Network Meta-analysis of the Short-term Results. — https://doi.org/10.1007/s00268-022-06829-x
[30] Meta-analysis of fenestrated endovascular aneurysm repair open surgical repair of juxtarenal abdominal aortic aneurysms over the last 10 years. — https://doi.org/10.1002/bjs5.50178
[31] Chimney vs. Fenestrated Endovascular vs. Open Repair for Juxta/Pararenal Abdominal Aortic Aneurysms: Systematic Review and Network Meta-Analysis of the Medium-Term Results. — https://doi.org/10.3390/jcm11226779
[32] Preoperative proteinuria is independently associated with mortality after fenestrated endovascular aneurysm repair. — https://doi.org/10.1016/j.jvs.2024.01.013
[33] Abdominal aortic aneurysm neck dilatation and sac remodeling in fenestrated compared to standard endovascular aortic repair. — https://doi.org/10.1177/17085381211052802
[35] Impact of Stent-Graft Complexity on Outcomes of Complex Abdominal Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis. — https://doi.org/10.1177/15266028251397841
[36] Fenestrated endovascular abdominal aortic aneurysm repair in octogenarians is associated with higher mortality and an increased incidence of nonhome discharge. — https://doi.org/10.1016/j.jvs.2022.01.076
[40] Comparison of Fenestrated Stentgrafts and Open Repair for Juxtarenal Aortic Aneurysms Using a Propensity Score Matching. — https://doi.org/10.1016/j.avsg.2023.05.031
[43] Editor's Choice - Comparison of Open, Standard, and Complex Endovascular Aortic Repair Treatments for Juxtarenal/Short Neck Aneurysms: A Systematic Review and Network Meta-Analysis. — https://doi.org/10.1016/j.ejvs.2021.12.042
[45] Fenestrated repair improves perioperative outcomes but lacks a hospital volume association for complex abdominal aortic aneurysms. — https://doi.org/10.1016/j.jvs.2020.05.039
[49] A Systematic Review of Contemporary Outcomes from Aortic Arch In Situ Laser Fenestration During Thoracic Endovascular Aortic Repair. — https://doi.org/10.1016/j.avsg.2023.01.009
[54] Midterm Outcomes and Aneurysm Sac Dynamics Following Fenestrated Endovascular Aneurysm Repair after Previous Endovascular Aneurysm Repair. — https://doi.org/10.1016/j.ejvs.2024.01.070
[55] Fenestrated and Chimney Technique for Juxtarenal Aortic Aneurysm: A Systematic Review and Pooled Data Analysis. — https://doi.org/10.1038/srep20497
[58] The use of fenestrated and branched endovascular aneurysm repair for juxtarenal and thoracoabdominal aneurysms: a systematic review and cost-effectiveness analysis. — https://doi.org/10.3310/hta18700
[59] Technique of implantation and bail-out maneuvers for endovascular fenestrated repair of juxtarenal aortic aneurysms. — https://doi.org/10.1177/1531003513512372
[64] Adoption and clinical outcomes of fenestrated endovascular aneurysm repair in a regional, multistate community hospital system. — https://doi.org/10.1016/j.jvs.2024.02.030
[73] The effect of supraceliac versus infraceliac landing zone on outcomes following fenestrated endovascular repair of juxta-/pararenal aortic aneurysms. — https://doi.org/10.1016/j.jvs.2022.08.007
[75] Association of Baseline Chronic Kidney Disease Stage With Short- and Long-Term Outcomes After Fenestrated Endovascular Aneurysm Repair. — https://doi.org/10.1016/j.avsg.2023.07.102
[78] Patient-specific computational flow simulation reveals significant differences in paravisceral aortic hemodynamics between fenestrated and branched endovascular aneurysm repair. — https://doi.org/10.1016/j.jvssci.2023.100183
[79] Systematic Review and Meta-analysis of Fenestrated and Chimney/Snorkel Techniques for Endovascular Repair of Juxtarenal Aortic Aneurysms. — https://doi.org/10.1177/15266028241231171
[83] Impact of stent-graft complexity on mid-term results in fenestrated endovascular aortic repair of juxtarenal and suprarenal abdominal aortic aneurysms. — https://doi.org/10.23736/s0021-9509.22.12311-6
[85] Use of steerable catheters for endovascular procedures: Report of a CASE and literature review. — https://doi.org/10.1002/ccd.28380
[101] Ultrasound Coded-Excitation Imaging for Endoleak Detection After Complex Endovascular Aortic Repair. — https://doi.org/10.1002/jum.16374
[102] Frailty as a Predictor of Mortality for Fenestrated EVAR and Open Surgical Repair of Aortic Aneurysms Involving Visceral Vessels. — https://doi.org/10.1016/j.avsg.2021.10.035
[105] Characterising the incidence and mode of visceral stent failure after fenestrated endovascular aneurysm repair (FEVAR). — https://doi.org/10.1177/20480040211012503
[106] Large-Diameter Fenestrated Endograft Repair of Abdominal Aortic Aneurysms Is Not Associated With Medium-Term Outcomes. — https://doi.org/10.1016/j.jss.2024.01.023
[115] Comparative clinical study of short-term outcomes between table fenestrated and chimney endovascular aneurysm repair for hostile neck aneurysms. — https://doi.org/10.1177/17085381221135859
[118] Presentation and Outcomes of Elective and Nonelective Complex Endovascular Repair for Thoracoabdominal and Juxtarenal Aortic Aneurysms. — https://doi.org/10.1016/j.avsg.2023.09.001
[127] Incidence and Clinical Significance of Renal Infarct After Fenestrated Endovascular Aortic Aneurysm Repair. — https://doi.org/10.2214/ajr.16.16562
[129] Midterm Outcomes of BeGraft Stent Grafts Used as Bridging Stents in Fenestrated Endovascular Aortic Aneurysm Repair. — https://doi.org/10.1177/15266028221091894
[130] Clinical Impact and Determinants of Fenestration to Target Vessel Misalignment in Fenestrated Endovascular Aortic Repair. — https://doi.org/10.1016/j.ejvs.2023.10.016
[133] Upper extremity access for fenestrated endovascular aortic aneurysm repair is not associated with increased morbidity. — https://doi.org/10.1016/j.jvs.2014.06.113
[136] Stroke rate after endovascular aortic interventions in the Society for Vascular Surgery Vascular Quality Initiative. — https://doi.org/10.1016/j.jvs.2020.02.015
[137] Early Results and Technical Tips of Combining Iliac Branch Endoprostheses with Fenestrated Aortic Stent Grafts during Endovascular Repair of Complex Abdominal and Thoracoabdominal Aortic Aneurysms. — https://doi.org/10.1016/j.avsg.2021.11.010
[139] Outcomes and cost of fenestrated versus standard endovascular repair of intact abdominal aortic aneurysm in the United States. — https://doi.org/10.1016/j.jvs.2018.06.211
[142] Aneurysm Sac Dynamics and its Prognostic Significance Following Fenestrated and Branched Endovascular Aortic Aneurysm Repair. — https://doi.org/10.1016/j.ejvs.2023.11.033
[145] Effect of narrow paravisceral aorta on target vessel instability after fenestrated and branched endovascular aortic repair. — https://doi.org/10.1016/j.jvs.2023.09.039
[147] Impact of Target Visceral Vessel Anatomical Configuration on Early Complications Following Endovascular Repair of Thoracoabdominal Aortic Aneurysms. — https://doi.org/10.1016/j.avsg.2021.10.044
[151] Obesity is Not Associated with Adverse Perioperative or Poorer Clinical Outcomes following Thoracic and Fenestrated-Branched Endovascular Aortic Repair. — https://doi.org/10.1016/j.avsg.2023.04.002
[153] Outcome of the Be Graft Bridging Stent in Fenestrated Endovascular Aortic Repair in a High-Volume Single Center and an Overview of Current Evidence. — https://doi.org/10.1177/15266028241231882
[154] Post-Operative and Mid-Term Renal Function Impairment Following Elective Fenestrated Endovascular Aortic Repair for Complex Aortic Aneurysms: Incidence and Risk Factors Analysis. — https://doi.org/10.3390/diagnostics13111955
[155] Medium-term outcomes of fenestrated endovascular repair of juxtarenal abdominal aortic aneurysms. — https://doi.org/10.1111/ans.14162
[158] Early Experience with Fenestrated Endovascular Compared to Open Repair of Complex Abdominal Aortic Aneurysms in a High-Volume Open Aortic Center. — https://doi.org/10.1016/j.avsg.2017.10.017
[159] Patient-specific changes in aortic hemodynamics is associated with thrombotic risk after fenestrated endovascular aneurysm repair with large diameter endografts. — https://doi.org/10.1016/j.jvssci.2022.04.002
[170] Fenestrated Endovascular Aortic Repair and Open Surgical Repair in Patients with Type Ia Endoleak after Endovascular Aneurysm Repair: a French Multicentre Cohort Study with Propensity Score Matching. — https://doi.org/10.1016/j.ejvs.2025.10.034
[171] Evaluation and Verification of Fast Computational Simulations of Stent-Graft Deployment in Endovascular Aneurysmal Repair. — https://doi.org/10.3389/fmedt.2021.704806
[180] Two-year evaluation of fenestrated and parallel branch endografts for the treatment of juxtarenal, suprarenal, and thoracoabdominal aneurysms at a single institution. — https://doi.org/10.1016/j.jvs.2019.03.058
[189] Fenestrated endovascular repair of abdominal aortic aneurysms is associated with increased morbidity but comparable mortality with infrarenal endovascular aneurysm repair. — https://doi.org/10.1016/j.jvs.2014.10.025
[191] Select type I and type III endoleaks at the completion of fenestrated endovascular aneurysm repair resolve spontaneously. — https://doi.org/10.1016/j.jvs.2018.09.066
[192] Projected Survival Benefit of Fenestrated Endovascular Aneurysm Repair versus Observation for Complex Abdominal Aortic Aneurysms in Patients with Limited Life Expectancy. — https://doi.org/10.1016/j.avsg.2025.07.005
[201] Association Between Type of Anaesthesia and Clinical Outcome in Patients Undergoing Endovascular Repair of Thoraco-Abdominal Aortic Aneurysms by Fenestrated and Branched Endografts. — https://doi.org/10.1016/j.ejvs.2022.07.010
[202] Steerable sheath for exclusively femoral bilateral extension of previous fenestrated endovascular aneurysm repair with iliac branch devices. — https://doi.org/10.1016/j.jvscit.2021.04.002
[208] Use of a 2 Dimensional Vessel Navigator Roadmap Decreases Patient Radiation Dose Compared to Standard 3D Mapping for Fenestrated Endovascular Aneurysm Repair. — https://doi.org/10.1016/j.avsg.2021.08.042
[211] Significant aortic neck dilation occurs after repair of juxtarenal aneurysms with fenestrated endovascular aneurysm repair. — https://doi.org/10.1016/j.jvs.2021.03.060
[213] Short- and Midterm Outcomes of Open Repair and Fenestrated Endografting of Pararenal Aortic Aneurysms in a Concurrent Propensity-Adjusted Comparison. — https://doi.org/10.1177/1526602818820090
[214] The benefit of combined carbon dioxide automated angiography and fusion imaging in preserving perioperative renal function in fenestrated endografting. — https://doi.org/10.1016/j.jvs.2020.02.051
[220] Thirty-day outcomes after fenestrated endovascular repair are superior to open repair of abdominal aortic aneurysms involving visceral vessels. — https://doi.org/10.1016/j.jvs.2017.04.057
[233] A propensity-matched comparison of outcomes for fenestrated endovascular aneurysm repair and open surgical repair of complex abdominal aortic aneurysms. — https://doi.org/10.1016/j.jvs.2014.04.011
[234] Use of the Zenith Fenestrated platform to rescue failing endovascular and open aortic reconstructions is safe and technically feasible. — https://doi.org/10.1016/j.jvs.2018.01.038
[239] Three-dimensional fusion computed tomography decreases radiation exposure, procedure time, and contrast use during fenestrated endovascular aortic repair. — https://doi.org/10.1016/j.jvs.2014.07.097
[240] "Awake" Spinal Cord Monitoring Under Local Anesthesia and Conscious Sedation in Fenestrated and Branched Endovascular Aortic Repair. — https://doi.org/10.1177/15266028211028207
[246] Preliminary Outcomes of Viabahn Balloon-Expandable Endoprosthesis as Bridging Stent in Renal Arteries During Fenestrated Endovascular Aortic Repair. — https://doi.org/10.1177/15266028211012403
[254] Five Year Results of Off the Shelf Fenestrated Endografts for Elective and Emergency Repair of Juxtarenal Abdominal Aortic Aneurysm. — https://doi.org/10.1016/j.ejvs.2020.12.012
[263] Implementation of a bundled protocol significantly reduces risk of spinal cord ischemia after branched or fenestrated endovascular aortic repair. — https://doi.org/10.1016/j.jvs.2017.05.136
[264] The Interplay between Preoperative Anemia and Postoperative Blood Transfusion on Survival following Fenestrated Aortic Aneurysm Repair. — https://doi.org/10.1016/j.avsg.2020.06.040
[267] The Influence of 3D Printed Aortic Models on the Evolution of Physician Modified Stent Grafts for the Urgent Treatment of Thoraco-abdominal and Pararenal Aortic Pathologies. — https://doi.org/10.1016/j.ejvs.2020.10.023
[269] Technique for Fenestrated Stent-Graft Implantation as a Proximal Extension to a Previous Fenestrated Endovascular Repair for Abdominal Aortic Aneurysm. — https://doi.org/10.1177/1526602817745779
[270] Computed tomography angiography-fluoroscopy image fusion allows visceral vessel cannulation without angiography during fenestrated endovascular aneurysm repair. — https://doi.org/10.1016/j.jvs.2017.11.062
[273] Impact of Polar Renal Artery Coverage after Fenestrated Endovascular Aortic Repair for Juxtarenal and Type IV Thoracoabdominal Aortic Aneurysms. — https://doi.org/10.1016/j.avsg.2018.10.040
[274] Fenestrated Endovascular Repair With Large Device Diameters (34-36 mm) is Associated With Type 1 and 3 Endoleak and Reintervention. — https://doi.org/10.1016/j.avsg.2021.07.055
[277] Cost-effectiveness analysis of surgical repair versus observation of complex abdominal aortic aneurysms in elderly patients. — https://doi.org/10.1016/j.jvs.2025.09.051
[280] Procedural and perioperative results in patients treated with fenestrated endovascular aneurysm repair planned by automated software in a physician-sponsored investigational device exemption trial of physician-modified endografts. — https://doi.org/10.1016/j.jvs.2018.02.045
[286] Fenestrated endovascular aneurysm repair-induced acute kidney injury does not result in chronic renal dysfunction. — https://doi.org/10.1016/j.jvs.2018.09.044
[289] Open repair versus EVAR with parallel grafts in patients with juxtarenal abdominal aortic aneurysm excluded from fenestrated endografting. — https://doi.org/10.23736/s0021-9509.21.11833-6
[291] Fenestrated and branched endovascular aortic repair for chronic type B aortic dissection with thoracoabdominal aneurysms. — https://doi.org/10.1016/j.jvs.2013.01.049
[295] The effect of early reintervention on late outcomes following infrarenal and fenestrated endovascular aneurysm repair. — https://doi.org/10.1016/j.jvs.2025.10.096
[301] Open Iliac Conduits Enabling the New Era of Endovascular Aortic Repair in Hostile Iliofemoral Anatomy: A Single-Center Retrospective Study. — https://doi.org/10.3390/medicina62010017
[304] Sex-stratified outcome differences between fenestrated endovascular aneurysm repair and open repair for juxtarenal abdominal aortic aneurysms. — https://doi.org/10.1016/j.jvs.2025.05.011
[305] Decision uncertainty and value of further research: a case-study in fenestrated endovascular aneurysm repair for complex abdominal aortic aneurysms. — https://doi.org/10.1186/s12962-018-0098-7
[309] Prospective Multicentre Cohort Study of Fenestrated and Branched Endografts After Failed Endovascular Infrarenal Aortic Aneurysm Repair with Type Ia Endoleak. — https://doi.org/10.1016/j.ejvs.2021.06.019
[313] Utilizing CO Cone Beam Computed Tomography for Post-Procedure Completion Control Following Fenestrated Endovascular Repair of Complex Aortic Aneurysm With a Standardized CO Protocol. — https://doi.org/10.1177/15266028251327041
[319] Early Results from the BeSafe Multicentre Prospective Study Evaluating a New Dedicated Bridging Stent for Fenestrated Endovascular Aneurysm Repair. — https://doi.org/10.1016/j.ejvs.2025.10.057
[323] Gender and perioperative outcomes after fenestrated endovascular repair using custom-made and off-the-shelf devices. — https://doi.org/10.1016/j.jvs.2016.02.062
[326] Editor's Choice - Acute Kidney Injury (AKI) in Aortic Intervention: Findings From the Midlands Aortic Renal Injury (MARI) Cohort Study. — https://doi.org/10.1016/j.ejvs.2019.09.508
[329] Fenestrated Endovascular Aortic Aneurysm Repair as a First Line Treatment Option to Treat Short Necked, Juxtarenal, and Suprarenal Aneurysms. — https://doi.org/10.1016/j.ejvs.2015.12.014
[330] Operative and Midterm Outcomes of the Fenestrated Anaconda Stent-Graft in the Endovascular Treatment of Juxtarenal, Suprarenal, and Type IV Thoracoabdominal Aortic Aneurysms. — https://doi.org/10.1177/1526602816667281
[331] 3D Printed Abdominal Aortic Aneurysm Phantom for Image Guided Surgical Planning with a Patient Specific Fenestrated Endovascular Graft System. — https://doi.org/10.1117/12.2253902
[332] Preoperative Hypoalbuminemia is a Risk Factor for Early and Late Mortality in Patients Undergoing Endovascular Juxtarenal and Thoracoabdominal Aortic Aneurysm Repair. — https://doi.org/10.1016/j.avsg.2017.03.058
[337] International Collaborative Study Comparing Outcomes of Fenestrated Endovascular Aortic Repair in Octogenarian Versus Nonoctogenarian Patients: The FEVOC Study. — https://doi.org/10.1097/sla.0000000000006300
[344] A prospective randomized trial of remote renal ischemic preconditioning for reducing nephropathy risk following fenestrated endovascular aortic aneurysm repair. — https://doi.org/10.1016/j.jvs.2025.02.017
[347] Lower extremity compartment syndrome after elective percutaneous fenestrated endovascular repair of an abdominal aortic aneurysm. — https://doi.org/10.1016/j.jvscit.2016.10.009
[349] Physician-Modified Fenestrated Endografts for Managing the Ruptured or Symptomatic Aortic Aneurysm: Technique Overview and Clinical Outcomes. — https://doi.org/10.1177/1538574418789023
[355] Technical Aspects and Outcome of Multi-Staged and Single-Staged Thoracoabdominal Fenestrated Endovascular Aortic Repair. — https://doi.org/10.1177/15266028241255533
[366] Endovascular aortic repair with the custom-made cook fenestrated device for the treatment of complex abdominal aortic aneurysms. — https://doi.org/10.1177/02184923261434634
[368] Elective Fenestrated and Branched Endovascular Thoraco-abdominal Aortic Repair with Supracoeliac Sealing Zones and without Prophylactic Cerebrospinal Fluid Drainage: Early and Medium-term Outcomes. — https://doi.org/10.1016/j.ejvs.2018.12.012
[370] Ruptured Juxtarenal Abdominal Aortic Aneurysm Treated With a Fenestrated EVAR Graft Intended for a Different Patient. — https://doi.org/10.1177/1538574416655897
[371] Prospective, Multicentre Physician Initiated Trial Investigating the BeGraft Stent Graft as Bridging Stent in Fenestrated Endovascular Aortic Repair for Complex Aortic Aneurysms. — https://doi.org/10.1016/j.ejvs.2026.01.053
[376] Could four-dimensional contrast-enhanced ultrasound replace computed tomography angiography during follow up of fenestrated endografts? Results of a preliminary experience. — https://doi.org/10.1016/j.ejvs.2014.05.025
[377] Impact of a new stepped balloon for bridging stent implantation on procedural time and radiation exposure in fenestrated endovascular aortic repair. — https://doi.org/10.1016/j.jvs.2025.08.027
[384] Development and Validation of a Deep Learning-Based Segmentation Method for Fenestration Marker and Graft Body Identification in Fenestrated Endovascular Aortic Repair. — https://doi.org/10.1177/15266028261437610
[391] Retrospective Evaluation of Percutaneous Access for TEVAR and EVAR: Time to Make it the Standard Approach? — https://doi.org/10.1055/s-0043-101387
[397] Comparison of Biomechanical Properties of the iCover and VBX Stent Grafts When Used as Bridge Stents in Fenestrated Endografts: An In Vitro Study. — https://doi.org/10.1177/15266028241289291