The early experience of f-EVAR was similar to that of sn-EVAR in terms of patient demographics, case selection, and procedural characteristics. A significant portion of the learning curve for both procedures, particularly for f-EVAR, lies in the preoperative planning of fenestrations and the cannulation of branch vessels. Similar short-term postoperative outcomes between these two particular techniques indicate that both will have utility in the treatment of high-risk patients with complex anatomy.
Even with the custom design of currently available fenestrated technology, shuttering of the SMA occurred in one-half of the patients in our cohort, although no clinical events were noted. Further details of the incidence, magnitude, and tolerance of SMA shuttering during f-EVAR are warranted to fully understand the clinical implication of this radiographic finding. Future design considerations for advanced EVAR should take into account SMA shuttering to further refine operative planning.
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