title: Debate: whether fenestrated endografts should be limited to a small number of specialized centers.
abstract: Until fairly recently, experience with advanced endovascular technologies, including fenestrated endovascular repair (FEVAR), has been limited to a relatively small number of practitioners worldwide. Excellent outcomes have been achieved by these accomplished surgeons who, at least initially, have primarily used custom-made devices constructed by a single endograft manufacturer. Access to this technology has been limited by the skills necessary for such procedures and by the customization process with industry partners. However, several issues are changing rapidly with FEVAR. Increasing numbers of surgeons now have the necessary endovascular skills, and off-the-shelf endografts from several manufacturers have become, or are becoming, available. Also, the regulatory landscape is changing with device approval in the United States. Surgeons and patients alike are anticipating the widespread adoption of this advanced technology that will surely benefit increasing numbers of patients. Or will it? Will widespread adoption in a larger number of smaller-volume hospitals, by less experienced surgeons, result in poor patient outcomes, or will excellent results continue with more patients benefitting from these technologic advances? These are important questions to ask before such adoption and are the subject of this debate.
authors: Vascular Surgery, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France. stephan.haulon@chru-lille.fr
authors: Stéphan
authors: S
authors: Haulon
authors: David
authors: D
authors: Barillà
authors: Mark
authors: M
authors: Tyrrell
authors: Nikolaos
authors: N
authors: Tsilimparis
authors: Joseph J
authors: JJ
authors: Ricotta
mesh_terms: D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D002983:Clinical Competence; D017076:Computer-Aided Design; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D019983:Guideline Adherence; D061847:Hospitals, High-Volume; D006801:Humans; D059032:Learning Curve; D061214:Patient Safety; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012307:Risk Factors; D013038:Specialization; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome