title: Fenestrated endovascular aneurysm repair.
abstract: BACKGROUND
  Fenestrated endovascular aneurysm repair (FEVAR) is a technically challenging operation. The duration, blood loss, and risk of limb ischaemia, contrast-induced nephropathy and reperfusion injury are likely to be higher than after standard endovascular aneurysm repair (EVAR). Benefits of FEVAR over open repair may be less than those seen with standard infrarenal EVAR. This paper is a meta-analysis of observational studies of all published data for FEVAR, with the aim to highlight current issues around the evidence for the potential benefit of FEVAR.
  
  
  METHODS
  A search was performed for studies describing FEVAR for juxtarenal abdominal aortic aneurysms. Small series of fewer than ten procedures and studies describing predominantly branched endografts or FEVAR for aortic dissection were excluded. Authors of included papers were contacted to eliminate patient duplication.
  
  
  RESULTS
  Eleven studies were identified describing a total of 660 procedures. Definitions of aneurysm morphology were variable, and clear inclusion and exclusion criteria were not always documented. Double fenestrations were more common than triple or quadruple fenestrations. Target vessel perfusion rates ranged from 90·5 to 100 per cent. Eleven deaths occurred within 30 days, giving a 30-day proportional mortality rate of 2·0 per cent. Morbidity was poorly reported.
  
  
  CONCLUSIONS
  FEVAR for repair of suprarenal and juxtarenal aneurysms is a viable alternative to open repair. However, there is no level 1 evidence for FEVAR, and current evidence is weak with many unanswered questions.
authors.affiliation: Multidisciplinary Endovascular Team, University College Hospital, London, UK. jane.cross@yahoo.co.uk
authors.forename: J
authors.initials: J
authors.lastname: Cross
authors.forename: K
authors.initials: K
authors.lastname: Gurusamy
authors.forename: V
authors.initials: V
authors.lastname: Gadhvi
authors.forename: D
authors.initials: D
authors.lastname: Simring
authors.forename: P
authors.initials: P
authors.lastname: Harris
authors.forename: K
authors.initials: K
authors.lastname: Ivancev
authors.forename: T
authors.initials: T
authors.lastname: Richards
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000473:pathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002986:Clinical Trials as Topic; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D015607:Stents