Some of the names of medical procedures today are confusing at first glance. FEVAR is one such name. FEVAR stands for Fenestrated Endovascular Aneurysm Repair. It is an elaborate procedure performed to fix some aneurysms of your aorta, which is the largest artery in your body.
Here, we will discuss what FEVAR is, and why it is done. We’ll also know how it is done, what happens, and why it is a lifesaver.
What Is FEVAR
FEVAR stands for Fenestrated Endovascular Aneurysm Repair. It is a low-invasive surgery that surgeons undertake to fix abdominal aorta aneurysms.
It occurs when one of your arteries becomes weakened. It begins to bulge like a balloon. When the balloon ruptures, hemorrhaging occurs that is lethal. Worst of all is that an aneurysm occurs in the aorta, the biggest artery that distributes blood from your heart to the rest of your body.
When an open repair is done for an aneurysm, doctors open the belly wide to fix the weakened portion. But in FEVAR, doctors do so less invasively. The doctors put a specially made stent graft (a cylinder lined with cloth) up through small incisions in the groins into the body and push it up to the aorta and close off the weakened part.
The “fenestrated” aspect is that the graft contains very fine, carefully constructed holes (fenestrations) within it. The opening gives space for the much smaller-diameter arteries (e.g., to the liver or kidney) to pass in and block off the aneurysm at the same time.
Why Is the FEVAR Procedure Performed?
FEVAR is done to prevent rupture of an aortic aneurysm, i.e., death. Rupture would lead to acute, catastrophic hemorrhage, and immediate death if it ruptures.
Doctors order FEVAR when:
- The aneurysm is proximal or close to the kidneys or other central arteries.
- The aneurysm is too big or eccentric to be repaired by open surgery.
- The patient cannot undergo open repair based on age, disease, or healing complication.
FEVAR gives surgeons the opportunity to repair the aneurysm while leaving vital blood supply to organs undisturbed.
How Does the FEVAR Process Work?
FEVAR is complex but can be broken down into a series of steps:
- Planning and imaging – Doctors use CT scans to carefully plan ahead for the aneurysm and the other arteries before surgery. They build a stent graft with holes in just the right locations.
- Anesthesia – The patient is given anesthesia. So that they will not feel pain.
- Small cuts – The doctor makes tiny cuts in the groin area. So he can reach the femoral arteries (the large leg arteries).
- Insertion of the catheter – A small tube called a catheter is placed in the artery. The stent graft is guided along the catheter.
- X-ray guidance – Surgeons guide the stent graft down the artery and into the aorta through real-time X-rays.
- Rolling out the stent graft – The stent graft is inflated in the aorta. It envelops the diseased portion without blocking side arteries.
- Restoring circulation – The stent graft offers a new pathway of open circulation, without compressing on the aneurysm wall.
- Closing cuts – The little cuts are closed, and the operation is complete.
The operation takes a few hours, and since it is less invasive than open surgery, recovery also takes less time.
Advantages of the FEVAR Process
The FEVAR process is better than the earlier open surgery in several ways:
- Less invasive – There isn’t a large abdominal cut required.
- Rapid recovery – Patients recover faster and can be out of the hospital sooner.
- Less discomfort – Less cuts are less uncomfortable.
- Less dangerous for some patients – It is gentler to sick or older patients.
- Remains open vital arteries – The windows, or fenestrations, leave larger arteries like these open.
Risks of FEVAR Procedure
As with any surgery, FEVAR is dangerous. They are:
- Wound infection.
- Bleeding during surgery or operation.
- Difficulty getting blood into the kidneys or intestines.
- Leaks due to stent graft (endoleaks).
- Migration of stent graft in the future from its original location.
- Future follow-up surgery required.
Physicians consider risks versus benefits before they recommend FEVAR.
Recovery After FEVAR
Brief hospital stay after FEVAR vs. open surgery. The patient spends 3–5 days in the hospital. Recovery essentials are the following:
- Hospitalization – Usually 3–5 days.
- Observation – Physicians keep checking blood pressure, kidney function, and circulation regularly.
- Pain control – Pain decreased.
- Walking – Early ambulation to avoid blood clots.
- Follow-up imaging – Ultrasound or CT scan is repeated to check the functioning of the graft successfully.
Recovery is completed in a few weeks based on the overall health of the patient.
Who Can Be a Candidate to Undergo the FEVAR Procedure?
FEVAR is not done in all patients who have an aneurysm. Doctors usually reserve it for:
- Patients with renal artery aneurysms.
- Patients in whom aneurysms cannot be repaired using the standard endovascular stent grafts.
- Patients who are too sick or too frail to undergo standard open repair.
Preparation for FEVAR Procedure
The doctor may have done the following before FEVAR:
- Medical testing – Lab tests, EKG, CT scans.
- Medications altered – Some medications like blood thinners must be stopped.
- Lifestyle modifications – Quit smoking, diet, and blood pressure control.
- Talk to your doctor – Discuss and make a decision regarding risk vs. benefit.
Life After FEVAR
Life after life after FEVAR is fine, but the patient has to adhere strictly to medical advice. Most important are:
- Follow-up as usual for stent graft surveillance.
- Medication or diet for hypertension management.
- Daily exercise as advised by the doctor.
- Balanced diet to ensure healthy arteries.
- Shun cigarette smoking, which kills arteries.
Healthy life for most of the patients with proper post-operative care after FEVAR.
FAQs
How long is the operation?
Typically 2–4 hours depending on the complexity.
Is FEVAR painful?
No, not due to anesthesia. It is usually mild afterward.
How long will I have to stay in the hospital?
Most stay 3–5 days in the hospital.
Will the stent graft ever fail?
Not necessarily.
Leakage or migration will occur sometimes, with follow-up required.
What is the success rate of FEVAR?
FEVAR should fix aneurysms if surgeons doing the procedure are skilled.
FEVAR is a life-saving option for those who have aortic aneurysms that could very well kill them. FEVAR is less risky, safer in most patients, and easier to recover from. While not risk-free, its benefit will usually overcome risk for less-than-optimal candidates for traditional surgery.
If you or your first-degree relative has been told that he or she needs to undergo aneurysm repair, ask your doctor if FEVAR would be ideal. Because of the innovations brought by medical technology, this procedure offers the patient a second chance at life.
