Fenestrated Endovascular Aortic Repair (FEVAR)
Fenestrated Endovascular Aortic Repair (FEVAR) is an advanced, minimally invasive procedure used to treat complex abdominal aortic aneurysms (AAA) located near vital branching arteries such as those supplying the kidneys, liver, and intestines.
Standard EVAR may not be suitable when aneurysms are too close to these arteries. FEVAR uses a custom-designed stent graft with small openings (fenestrations) that maintain blood flow to critical organs while sealing off the aneurysm to prevent rupture.
When Is FEVAR Performed?
FEVAR is indicated when:
- The aneurysm is close to or involves critical branches of the aorta.
- Standard EVAR isn’t feasible due to anatomical limitations.
- The aneurysm poses a high rupture risk but open surgery carries significant risk.
Understanding FEVAR
Who Is a Candidate for FEVAR?
You may be considered for FEVAR if:
- Your aneurysm’s location is unsuitable for standard EVAR.
- You have medical risks that make open surgery less safe.
- Imaging confirms that a fenestrated graft can safely fit your anatomy.
Not all centers provide FEVAR. RIVEA specializes in this advanced procedure.
How to Prepare for FEVAR
Preparation steps include:
- CT Angiogram with 3D Vessel Mapping for graft design.
- Blood pressure, cholesterol, and smoking management.
- Preoperative testing including labs and heart function assessment.
- Medication review and adjustments.
Custom grafts are made specifically for your anatomy. This process can take several weeks before your procedure.
What Happens During FEVAR?
- Anesthesia: General anesthesia is used for patient comfort.
- Access: Small incisions in both groins to access femoral arteries.
- Guide Wire and Catheter: A guide wire and catheter are positioned using fluoroscopy.
- Graft Deployment: The custom fenestrated stent graft is carefully positioned so its openings align with branch arteries.
- Branch Vessel Stenting: Additional stents may be placed through fenestrations to support blood flow to organs.
- Final Imaging and Closure: Imaging confirms placement before closing incisions with bandages.
The procedure takes 4–6 hours depending on complexity. Hospital stay is usually 2–5 days.
Post-Procedure Care
- Hospital Stay: Typically 2–5 days due to added complexity.
- Activity Restrictions: Similar to EVAR—limit heavy lifting and follow incision care instructions.
- Medications: Blood pressure control is especially critical after FEVAR.
- Follow-Up: Lifelong imaging is essential, with checks at 1, 6, and 12 months, then annually.
Potential Risks
- Endoleaks or graft misalignment
- Blockage of critical branch vessels
- Kidney function impairment
- Bleeding, infection, or nerve injury
- Stroke or heart complications (rare)
Why choose FEVAR?
- Treats aneurysms unsuitable for standard EVAR.
- Avoids open surgery in high-risk patients.
- Protects blood flow to vital organs.
- Shorter recovery time and hospital stay compared to open surgery.
Why choose RIVEA for FEVAR?
Led by Dr. Karthik Mikkineni, Co-founder and Chief Vascular Specialist, RIVEA offers:
- U.S.-Trained Expertise: Dr. Mikkineni brings advanced international training in complex endovascular procedures, including EVAR and FEVAR.
- Specialized Aortic Expertise: RIVEA is a preferred center for complex aortic aneurysm care in India, including patients referred after unsuccessful treatments elsewhere.
- Customized Treatments: Our team uses advanced imaging and precise measurements to tailor stent grafts for each patient.
- Innovation and Research: We use the latest endovascular techniques and stay at the forefront of aortic treatment advances.
FAQs
Is FEVAR riskier than EVAR?
FEVAR is more complex but still safer than open surgery for many patients with difficult aneurysm anatomy.
Does the stent graft need to be replaced?
Typically, no. However, follow-up imaging is essential to detect any changes over time.
Will I feel the graft inside me?
No. The stent graft is internal and does not cause sensations or discomfort once in place.
How long does graft customization take?
Custom grafts for FEVAR may take several weeks to manufacture after your initial evaluation.
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Dr. Karthik Mikkineni
MD, FACS, FSVS, RPVI
Dr. Karthik Mikkineni is an internationally recognized vascular and endovascular surgeon, known for his pioneering work in complex aortic interventions, limb salvage, and carotid disease management.
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