Conversion of failed endovascular infrarenal aortic aneurysm repair with fenestrated/branched stent grafts

Fenestrated and branched endovascular aneurysm repair (F/BEVAR) can be used to salvage infrarenal endovascular aneurysm repairs (EVARs) that fail secondary to inadequate proxi-mal seal or progressive proximal aneurysmal disease. Extending the aneurysmal seal zone proximally can be performed without compromising flow to renal and visceral vasculature. Device planning requires adapting for prior endograft length and may involve a tubular or bifurcated design. Technical difficulties include navigating in the constrained space of the prior endograft and cannulating target vessels through suprarenal fixation devices. Strate-gies to optimize success include brachial/axillary access, use of diameter reducing ties, preloaded wires, and steerable sheaths. Reported technical success rates range from 85% to 99% and long-term freedom from re-intervention rates range from 67% to 83%. F/BEVAR in patients with prior EVAR, compared with those without, is associated with similar mor-bidity, mortality, and freedom from re-intervention, albeit with increased operative and flu-oroscopic time. Compared with open surgery, F/BEVAR is associated with decreased morbid-ity and mortality. Alternatives to F/BEVAR treatment for inadequate proximal seal after in-frarenal EVAR include open conversion, chimney/snorkel endografting, physician-modified endografting, balloon expandable uncovered stent, embolization, and endostapling.(c) 2022 Elsevier Inc. All rights reserved.