Endovascular Solutions for Abdominal Aortic Aneurysms: Fenestrated, Branched and Custom-Made Devices
Background Abdominal aortic aneurysm (AAA) has a prevalence of 4.8%. AAA rupture is associated with significant mortality, thus surgical intervention is generally required once the aneurysm diameter exceeds 5.5 cm. Endovascular aneurysm repair (EVAR) is the predominant repair modality for AAA. Howev...
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| Veröffentlicht in: | Vascular and Endovascular Surgery 2025-01, Vol.59 (1), p.64-75 |
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| creator | Cox, Kofi Yip, Ho Cheung Anthony Geragotellis, Alexander Al-Tawil, Mohammed Jubouri, Matti Williams, Ian M. Bashir, Mohamad |
| description | Background
Abdominal aortic aneurysm (AAA) has a prevalence of 4.8%. AAA rupture is associated with significant mortality, thus surgical intervention is generally required once the aneurysm diameter exceeds 5.5 cm. Endovascular aneurysm repair (EVAR) is the predominant repair modality for AAA. However, in patients with complex aortic anatomy, fenestrated or branched EVAR is a superior repair option vs standard EVAR. Fenestrated and branched endoprostheses can be off-the-shelf or custom-made, which offers a more individualised approach.
Aim
To summarise and evaluate the clinical outcomes achieved by fenestrated EVAR (FEVAR) and branched EVAR (BEVAR), and to explore the role of custom-made endoprostheses in contemporary AAA management.
Methods
A literature search using Ovid Medline and Google Scholar was conducted to identify literature pertaining to the use and outcomes of fenestrated, branched, fenestrated-branched and custom-made endoprostheses for AAA repair.
Results
FEVAR is an effective repair modality for patients with AAA that offers similar early survival, improved early morbidity but higher rates of reintervention in comparison to open surgical repair (OSR). Compared with standard EVAR, FEVAR is associated with similar in-hospital mortality yet higher rates of morbidity, especially regarding renal outcomes. BEVAR outcomes are rarely reported exclusively in the context of AAA repair. When reported, BEVAR is an acceptable alternative to EVAR in the treatment of complex aortic aneurysms and has similar reported complication issues to FEVAR. Custom-made grafts are a good alternative treatment option for complex aneurysms where hostile aneurysm anatomy precludes the use of conventional EVAR and sufficient time is available for the manufacturing of such devices.
Conclusion
FEVAR offers a very effective treatment for patients with complex aortic anatomy and has been well-characterised over the past decade. RCTs and longer-term studies are desirable for unbiased comparison of non-standard EVAR modalities. |
| doi_str_mv | 10.1177/15385744231185606 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2827921817</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_15385744231185606</sage_id><sourcerecordid>2827921817</sourcerecordid><originalsourceid>FETCH-LOGICAL-c292t-6672ed5b5a678a21a905061e788758ec51129679383d56ea7f30c071e0ee65913</originalsourceid><addsrcrecordid>eNp9kE1PwzAMhiME4vsHcEE5cqAQJ8tHuY3BAAnEAThXWeJBp7YZSYu0f0_QgAsSJ1vy41f2Q8gRsDMArc9BCiP1aMQFgJGKqQ2yC6UwRQmgNnOf58UXsEP2UlowBgZGZpvsCC2EMbLcJf668-HDJjc0NtKn0Ax9HbpE5yHS8cyHtu5sQ8ch9rWj4w6HuEptuqBT7DD10fboT-lltJ17Q09t5-lkSH1oiwfrkV7hR-0wHZCtuW0SHn7XffIyvX6e3Bb3jzd3k_F94XjJ-0IpzdHLmbRKG8vBlkwyBaiN0dKgkwC8VDo_KLxUaPVcMMc0IENUsgSxT07WucsY3od8X9XWyWHT2A7DkCpuuC55lqAzCmvUxZBSxHm1jHVr46oCVn3Jrf7IzTvH3_HDrEX_u_FjMwNnayDZV6wWYYhZXvon8RPyFoCg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2827921817</pqid></control><display><type>article</type><title>Endovascular Solutions for Abdominal Aortic Aneurysms: Fenestrated, Branched and Custom-Made Devices</title><source>Access via SAGE</source><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Cox, Kofi ; Yip, Ho Cheung Anthony ; Geragotellis, Alexander ; Al-Tawil, Mohammed ; Jubouri, Matti ; Williams, Ian M. ; Bashir, Mohamad</creator><creatorcontrib>Cox, Kofi ; Yip, Ho Cheung Anthony ; Geragotellis, Alexander ; Al-Tawil, Mohammed ; Jubouri, Matti ; Williams, Ian M. ; Bashir, Mohamad</creatorcontrib><description>Background
Abdominal aortic aneurysm (AAA) has a prevalence of 4.8%. AAA rupture is associated with significant mortality, thus surgical intervention is generally required once the aneurysm diameter exceeds 5.5 cm. Endovascular aneurysm repair (EVAR) is the predominant repair modality for AAA. However, in patients with complex aortic anatomy, fenestrated or branched EVAR is a superior repair option vs standard EVAR. Fenestrated and branched endoprostheses can be off-the-shelf or custom-made, which offers a more individualised approach.
Aim
To summarise and evaluate the clinical outcomes achieved by fenestrated EVAR (FEVAR) and branched EVAR (BEVAR), and to explore the role of custom-made endoprostheses in contemporary AAA management.
Methods
A literature search using Ovid Medline and Google Scholar was conducted to identify literature pertaining to the use and outcomes of fenestrated, branched, fenestrated-branched and custom-made endoprostheses for AAA repair.
Results
FEVAR is an effective repair modality for patients with AAA that offers similar early survival, improved early morbidity but higher rates of reintervention in comparison to open surgical repair (OSR). Compared with standard EVAR, FEVAR is associated with similar in-hospital mortality yet higher rates of morbidity, especially regarding renal outcomes. BEVAR outcomes are rarely reported exclusively in the context of AAA repair. When reported, BEVAR is an acceptable alternative to EVAR in the treatment of complex aortic aneurysms and has similar reported complication issues to FEVAR. Custom-made grafts are a good alternative treatment option for complex aneurysms where hostile aneurysm anatomy precludes the use of conventional EVAR and sufficient time is available for the manufacturing of such devices.
Conclusion
FEVAR offers a very effective treatment for patients with complex aortic anatomy and has been well-characterised over the past decade. RCTs and longer-term studies are desirable for unbiased comparison of non-standard EVAR modalities.</description><identifier>ISSN: 1538-5744</identifier><identifier>ISSN: 1938-9116</identifier><identifier>EISSN: 1938-9116</identifier><identifier>DOI: 10.1177/15385744231185606</identifier><identifier>PMID: 37338859</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Aortic Aneurysm, Abdominal - diagnostic imaging ; Aortic Aneurysm, Abdominal - mortality ; Aortic Aneurysm, Abdominal - surgery ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation - adverse effects ; Blood Vessel Prosthesis Implantation - instrumentation ; Blood Vessel Prosthesis Implantation - mortality ; Endovascular Procedures - adverse effects ; Endovascular Procedures - instrumentation ; Endovascular Procedures - mortality ; Humans ; Postoperative Complications - etiology ; Prosthesis Design ; Risk Factors ; Stents ; Time Factors ; Treatment Outcome</subject><ispartof>Vascular and Endovascular Surgery, 2025-01, Vol.59 (1), p.64-75</ispartof><rights>The Author(s) 2023</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c292t-6672ed5b5a678a21a905061e788758ec51129679383d56ea7f30c071e0ee65913</cites><orcidid>0000-0002-1681-4805 ; 0000-0001-7191-7885 ; 0000-0003-2111-8596</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/15385744231185606$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/15385744231185606$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,315,782,786,794,21826,27929,27931,27932,43628,43629</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37338859$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cox, Kofi</creatorcontrib><creatorcontrib>Yip, Ho Cheung Anthony</creatorcontrib><creatorcontrib>Geragotellis, Alexander</creatorcontrib><creatorcontrib>Al-Tawil, Mohammed</creatorcontrib><creatorcontrib>Jubouri, Matti</creatorcontrib><creatorcontrib>Williams, Ian M.</creatorcontrib><creatorcontrib>Bashir, Mohamad</creatorcontrib><title>Endovascular Solutions for Abdominal Aortic Aneurysms: Fenestrated, Branched and Custom-Made Devices</title><title>Vascular and Endovascular Surgery</title><addtitle>Vasc Endovascular Surg</addtitle><description>Background
Abdominal aortic aneurysm (AAA) has a prevalence of 4.8%. AAA rupture is associated with significant mortality, thus surgical intervention is generally required once the aneurysm diameter exceeds 5.5 cm. Endovascular aneurysm repair (EVAR) is the predominant repair modality for AAA. However, in patients with complex aortic anatomy, fenestrated or branched EVAR is a superior repair option vs standard EVAR. Fenestrated and branched endoprostheses can be off-the-shelf or custom-made, which offers a more individualised approach.
Aim
To summarise and evaluate the clinical outcomes achieved by fenestrated EVAR (FEVAR) and branched EVAR (BEVAR), and to explore the role of custom-made endoprostheses in contemporary AAA management.
Methods
A literature search using Ovid Medline and Google Scholar was conducted to identify literature pertaining to the use and outcomes of fenestrated, branched, fenestrated-branched and custom-made endoprostheses for AAA repair.
Results
FEVAR is an effective repair modality for patients with AAA that offers similar early survival, improved early morbidity but higher rates of reintervention in comparison to open surgical repair (OSR). Compared with standard EVAR, FEVAR is associated with similar in-hospital mortality yet higher rates of morbidity, especially regarding renal outcomes. BEVAR outcomes are rarely reported exclusively in the context of AAA repair. When reported, BEVAR is an acceptable alternative to EVAR in the treatment of complex aortic aneurysms and has similar reported complication issues to FEVAR. Custom-made grafts are a good alternative treatment option for complex aneurysms where hostile aneurysm anatomy precludes the use of conventional EVAR and sufficient time is available for the manufacturing of such devices.
Conclusion
FEVAR offers a very effective treatment for patients with complex aortic anatomy and has been well-characterised over the past decade. RCTs and longer-term studies are desirable for unbiased comparison of non-standard EVAR modalities.</description><subject>Aortic Aneurysm, Abdominal - diagnostic imaging</subject><subject>Aortic Aneurysm, Abdominal - mortality</subject><subject>Aortic Aneurysm, Abdominal - surgery</subject><subject>Blood Vessel Prosthesis</subject><subject>Blood Vessel Prosthesis Implantation - adverse effects</subject><subject>Blood Vessel Prosthesis Implantation - instrumentation</subject><subject>Blood Vessel Prosthesis Implantation - mortality</subject><subject>Endovascular Procedures - adverse effects</subject><subject>Endovascular Procedures - instrumentation</subject><subject>Endovascular Procedures - mortality</subject><subject>Humans</subject><subject>Postoperative Complications - etiology</subject><subject>Prosthesis Design</subject><subject>Risk Factors</subject><subject>Stents</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1538-5744</issn><issn>1938-9116</issn><issn>1938-9116</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2025</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1PwzAMhiME4vsHcEE5cqAQJ8tHuY3BAAnEAThXWeJBp7YZSYu0f0_QgAsSJ1vy41f2Q8gRsDMArc9BCiP1aMQFgJGKqQ2yC6UwRQmgNnOf58UXsEP2UlowBgZGZpvsCC2EMbLcJf668-HDJjc0NtKn0Ax9HbpE5yHS8cyHtu5sQ8ch9rWj4w6HuEptuqBT7DD10fboT-lltJ17Q09t5-lkSH1oiwfrkV7hR-0wHZCtuW0SHn7XffIyvX6e3Bb3jzd3k_F94XjJ-0IpzdHLmbRKG8vBlkwyBaiN0dKgkwC8VDo_KLxUaPVcMMc0IENUsgSxT07WucsY3od8X9XWyWHT2A7DkCpuuC55lqAzCmvUxZBSxHm1jHVr46oCVn3Jrf7IzTvH3_HDrEX_u_FjMwNnayDZV6wWYYhZXvon8RPyFoCg</recordid><startdate>20250101</startdate><enddate>20250101</enddate><creator>Cox, Kofi</creator><creator>Yip, Ho Cheung Anthony</creator><creator>Geragotellis, Alexander</creator><creator>Al-Tawil, Mohammed</creator><creator>Jubouri, Matti</creator><creator>Williams, Ian M.</creator><creator>Bashir, Mohamad</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1681-4805</orcidid><orcidid>https://orcid.org/0000-0001-7191-7885</orcidid><orcidid>https://orcid.org/0000-0003-2111-8596</orcidid></search><sort><creationdate>20250101</creationdate><title>Endovascular Solutions for Abdominal Aortic Aneurysms: Fenestrated, Branched and Custom-Made Devices</title><author>Cox, Kofi ; Yip, Ho Cheung Anthony ; Geragotellis, Alexander ; Al-Tawil, Mohammed ; Jubouri, Matti ; Williams, Ian M. ; Bashir, Mohamad</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c292t-6672ed5b5a678a21a905061e788758ec51129679383d56ea7f30c071e0ee65913</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2025</creationdate><topic>Aortic Aneurysm, Abdominal - diagnostic imaging</topic><topic>Aortic Aneurysm, Abdominal - mortality</topic><topic>Aortic Aneurysm, Abdominal - surgery</topic><topic>Blood Vessel Prosthesis</topic><topic>Blood Vessel Prosthesis Implantation - adverse effects</topic><topic>Blood Vessel Prosthesis Implantation - instrumentation</topic><topic>Blood Vessel Prosthesis Implantation - mortality</topic><topic>Endovascular Procedures - adverse effects</topic><topic>Endovascular Procedures - instrumentation</topic><topic>Endovascular Procedures - mortality</topic><topic>Humans</topic><topic>Postoperative Complications - etiology</topic><topic>Prosthesis Design</topic><topic>Risk Factors</topic><topic>Stents</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cox, Kofi</creatorcontrib><creatorcontrib>Yip, Ho Cheung Anthony</creatorcontrib><creatorcontrib>Geragotellis, Alexander</creatorcontrib><creatorcontrib>Al-Tawil, Mohammed</creatorcontrib><creatorcontrib>Jubouri, Matti</creatorcontrib><creatorcontrib>Williams, Ian M.</creatorcontrib><creatorcontrib>Bashir, Mohamad</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Vascular and Endovascular Surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cox, Kofi</au><au>Yip, Ho Cheung Anthony</au><au>Geragotellis, Alexander</au><au>Al-Tawil, Mohammed</au><au>Jubouri, Matti</au><au>Williams, Ian M.</au><au>Bashir, Mohamad</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Endovascular Solutions for Abdominal Aortic Aneurysms: Fenestrated, Branched and Custom-Made Devices</atitle><jtitle>Vascular and Endovascular Surgery</jtitle><addtitle>Vasc Endovascular Surg</addtitle><date>2025-01-01</date><risdate>2025</risdate><volume>59</volume><issue>1</issue><spage>64</spage><epage>75</epage><pages>64-75</pages><issn>1538-5744</issn><issn>1938-9116</issn><eissn>1938-9116</eissn><abstract>Background
Abdominal aortic aneurysm (AAA) has a prevalence of 4.8%. AAA rupture is associated with significant mortality, thus surgical intervention is generally required once the aneurysm diameter exceeds 5.5 cm. Endovascular aneurysm repair (EVAR) is the predominant repair modality for AAA. However, in patients with complex aortic anatomy, fenestrated or branched EVAR is a superior repair option vs standard EVAR. Fenestrated and branched endoprostheses can be off-the-shelf or custom-made, which offers a more individualised approach.
Aim
To summarise and evaluate the clinical outcomes achieved by fenestrated EVAR (FEVAR) and branched EVAR (BEVAR), and to explore the role of custom-made endoprostheses in contemporary AAA management.
Methods
A literature search using Ovid Medline and Google Scholar was conducted to identify literature pertaining to the use and outcomes of fenestrated, branched, fenestrated-branched and custom-made endoprostheses for AAA repair.
Results
FEVAR is an effective repair modality for patients with AAA that offers similar early survival, improved early morbidity but higher rates of reintervention in comparison to open surgical repair (OSR). Compared with standard EVAR, FEVAR is associated with similar in-hospital mortality yet higher rates of morbidity, especially regarding renal outcomes. BEVAR outcomes are rarely reported exclusively in the context of AAA repair. When reported, BEVAR is an acceptable alternative to EVAR in the treatment of complex aortic aneurysms and has similar reported complication issues to FEVAR. Custom-made grafts are a good alternative treatment option for complex aneurysms where hostile aneurysm anatomy precludes the use of conventional EVAR and sufficient time is available for the manufacturing of such devices.
Conclusion
FEVAR offers a very effective treatment for patients with complex aortic anatomy and has been well-characterised over the past decade. RCTs and longer-term studies are desirable for unbiased comparison of non-standard EVAR modalities.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>37338859</pmid><doi>10.1177/15385744231185606</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-1681-4805</orcidid><orcidid>https://orcid.org/0000-0001-7191-7885</orcidid><orcidid>https://orcid.org/0000-0003-2111-8596</orcidid></addata></record> |
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| ispartof | Vascular and Endovascular Surgery, 2025-01, Vol.59 (1), p.64-75 |
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| subjects | Aortic Aneurysm, Abdominal - diagnostic imaging Aortic Aneurysm, Abdominal - mortality Aortic Aneurysm, Abdominal - surgery Blood Vessel Prosthesis Blood Vessel Prosthesis Implantation - adverse effects Blood Vessel Prosthesis Implantation - instrumentation Blood Vessel Prosthesis Implantation - mortality Endovascular Procedures - adverse effects Endovascular Procedures - instrumentation Endovascular Procedures - mortality Humans Postoperative Complications - etiology Prosthesis Design Risk Factors Stents Time Factors Treatment Outcome |
| title | Endovascular Solutions for Abdominal Aortic Aneurysms: Fenestrated, Branched and Custom-Made Devices |
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