Our Summary

This research paper discusses a procedure to repair a specific type of aneurysm in a blood vessel below the kidneys. The procedure, called fenestrated and branched endovascular aneurysm repair (F/BEVAR), is used when previous repair attempts have failed due to issues with the sealing of the aneurysm or the aneurysm’s growth. The technique can be customized based on the previous repair attempt and can be performed without affecting blood flow to the kidneys and digestive system.

However, the procedure can be challenging due to the limited space inside the previously repaired blood vessel and the difficulty of reaching the aneurysm through devices used to stabilize the kidney. To overcome these challenges, the researchers recommend several strategies such as using different access points, using devices to reduce the diameter of the blood vessel, and guided sheaths.

The success rate of this procedure is between 85% to 99%, with a 67% to 83% chance of the patient not requiring further intervention. The procedure has similar risks of complications, death, and need for further intervention to previous repair attempts, although it takes longer to perform and requires more time under x-ray imaging.

Compared to traditional surgery, F/BEVAR has fewer risks of complications and death. If F/BEVAR is not suitable, other treatment options are available, including traditional surgery, other forms of endovascular repair, stenting, embolization (blocking the blood vessel), and stapling the blood vessel.

FAQs

  1. What is Fenestrated and branched endovascular aneurysm repair (F/BEVAR)?
  2. What strategies can be used to optimize the success of F/BEVAR?
  3. What are the alternative treatments for inadequate proximal seal after infrarenal EVAR?

Doctor’s Tip

One helpful tip a doctor might tell a patient about aortic aneurysm repair with fenestrated and branched endovascular techniques is to follow post-procedure instructions carefully and attend all follow-up appointments to monitor the success of the repair and ensure proper healing. It is important to maintain a healthy lifestyle, including regular exercise and a balanced diet, to reduce the risk of further complications. If any symptoms such as severe abdominal or back pain, shortness of breath, or sudden weakness occur, it is important to seek immediate medical attention.

Suitable For

Patients who are typically recommended for aortic aneurysm repair include those with aortic aneurysms that are large in size, rapidly expanding, symptomatic, or at risk of rupture. Additionally, patients with certain risk factors such as a family history of aortic aneurysms, smoking, high blood pressure, or atherosclerosis may also be recommended for repair. In cases where endovascular repair has been previously performed and has failed due to inadequate proximal seal or progressive proximal aneurysmal disease, fenestrated and branched endovascular aneurysm repair (F/BEVAR) may be recommended as a salvage procedure.

Timeline

  • Before aortic aneurysm repair:
  1. Patient undergoes diagnostic imaging to assess the size and location of the aneurysm.
  2. Consultation with a vascular surgeon to discuss treatment options.
  3. Pre-operative testing and evaluation to assess the patient’s overall health and readiness for surgery.
  4. Discussion of the risks and benefits of aortic aneurysm repair with the patient.
  5. Scheduling of the surgical procedure and pre-operative preparation.
  • After aortic aneurysm repair:
  1. Recovery in the hospital with monitoring of vital signs and pain management.
  2. Gradual resumption of normal activities under the guidance of healthcare providers.
  3. Follow-up appointments with the vascular surgeon for monitoring of the repaired aneurysm.
  4. Rehabilitation or physical therapy to regain strength and mobility.
  5. Long-term monitoring of the repaired aneurysm to assess for any complications or recurrence.

What to Ask Your Doctor

  1. What are the risks and benefits of undergoing aortic aneurysm repair using a fenestrated or branched endovascular approach compared to traditional open surgery?
  2. What is the success rate of this procedure in salvaging failed infrarenal endovascular aneurysm repairs?
  3. How will the device planning be adapted for my specific case, considering my prior endograft length?
  4. What technical difficulties or challenges should I be aware of during the procedure?
  5. What strategies will be used to optimize success and minimize complications during the procedure?
  6. What are the reported long-term outcomes and freedom from re-intervention rates for patients who undergo F/BEVAR for failed infrarenal EVAR?
  7. How does the morbidity and mortality rate of F/BEVAR compare to open surgery for treating inadequate proximal seal after infrarenal EVAR?
  8. What alternative treatment options are available if F/BEVAR is not feasible or recommended for my case?
  9. How will my recovery and follow-up care be different after undergoing aortic aneurysm repair using a fenestrated or branched endovascular approach?
  10. Are there any specific lifestyle changes or precautions I should take after the procedure to ensure the long-term success of the repair?

Reference

Authors: Jessula S, Eagleton MJ. Journal: Semin Vasc Surg. 2022 Sep;35(3):341-349. doi: 10.1053/j.semvascsurg.2022.06.004. Epub 2022 Jul 7. PMID: 36153075