FEVAR Procedure: Fenestrated Endovascular Repair
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Pain in your chest, belly, or back. Pulsing feelings in your belly. Feeling like you’ll pass out. If you're living with an aortic aneurysm, you're hoping for relief from these symptoms. You're probably worried about a rupture. You'll likely need surgery. And that can mean facing a long recovery.
If your aortic aneurysm is near your kidneys, the experts at UVA Health offer a special procedure called fenestrated endovascular aneurysm repair (FEVAR).
Care You Can't Get Everywhere
We’re one of the few hospitals in the country where you can get FEVAR. Also sometimes called branched endovascular aortic repair (BEVAR), it lets surgeons fix your aortic aneurysm without big cuts to your body. That means:
- A shorter hospital stay than open surgery (1-2 days)
- Faster recovery
- Smaller cuts & smaller scars
- Less chance of complications
In fact, Becker’s Hospital Review named UVA Health’s Heart & Vascular Center to its list of 100 hospitals and health systems with great heart programs.
See other awards and recognition for our heart care.
Getting FEVAR at UVA Health
A FEVAR procedure uses a special tube called an aortic stent-graft. The stent-graft is put inside your aorta where the aneurysm is growing. It acts as a support for the wall of your aorta. It helps keep your aneurysm from getting bigger or tearing.
A FEVAR stent-graft is custom-made for your aorta. It has holes in the side of it. These holes line up with other arteries that branch off of your aorta. The holes let blood flow from the aorta into those branching arteries. They're good for aortic aneurysms near your kidneys or in other places where you have branching arteries.
First Steps
We'll use high-tech imaging to find and measure your aneurysm. We use those pictures and information about your aneurysm to make your custom stent-graft.
FEVAR Procedure
To put it in place, we only use a small cut by your groin. Through there, we put a small, flexible tube into a blood vessel (endovascular). We send the stent-graft through the tube and put it in place that way (it's a minimally invasive procedure).
The procedure usually takes only a few hours. You can usually leave the hospital after 1 or 2 days.
After the procedure, you can quickly get back to your usual activities. We'll have check-ins with you over the next weeks and months to make sure the stent-graft is working.
Endovascular Aortic Aneurysm Repair
Endovascular aortic repairs treat aneurysms in your aorta without major surgery. At UVA Health, our Aortic Center’s surgical team has the deep experience and expertise needed for successful endovascular aortic aneurysm repairs.
John Kern, MD: Once a patient has an aneurysm that reaches a certain size that it becomes a risk to their wellbeing, we always look to see if we can possibly treat them in an endovascular way.
W. Darrin Clouse, MD: Endovascular surgery, or endovascular aneurysm repair, or endovascular aortic surgery is
all the terminology we use for catheter-based procedures. Most of the time we're able to do this through punctures in the groin arteries, or through a puncture in an arm artery or a small incision in an exposure of an arm artery, either at the shoulder or in the arm. And use wires and catheters to place these endovascular grafts and maintain flow in the branches of the aorta.
John Kern, MD: It's less invasive. The recovery time is quicker. In general, the risks associated with an endovascular repair are lower than the risks associated with an open repair.
W. Darrin Clouse, MD: The most common area in the aorta to develop aneurysms is what's called infrarenal, meaning below the kidneys. About 80% of aneurysms are actually below the kidneys. We go up one side or the other from the groin, and we actually implant a stent graft and join it to a stent graft that goes down into the other side toward the other femoral artery, and essentially exclude the aneurysm. Unlike open surgery, where we go in and we actually open the aneurysm and get rid of it, and sew in an open graft. With endovascular repair of the aorta and the aneurysm is still there.
Behzad Farivar, MD: Standard endograft and infrarenal endovascular aneurysm repair, or EVAR, is used to treat an infrarenal aortic aneurysm. TEVAR, or a thoracic endovascular aortic repair is used to treat an aneurysm in the descending thoracic aorta.
John Kern, MD: FEVAR is a fenestrated endovascular aneurysm repair, and BEVAR is a branched endovascular aneurysm repair. And the fenestrated and branched endografts are really the newest technologies when it comes to endovascular repairs. And we are fortunate to offer those options at UVA. The biggest thing for patients after an endovascular repair is the time in the hospital. And it's a lot quicker than with open repair. Often patients are in the hospital sometimes just overnight, and they're home the next day. And they only need to take it easy for a week or so, and then they're back at full activity.
W. Darrin Clouse, MD: UVA is uniquely equipped for endovascular aortic surgery and for less invasive procedures because of our hybrid operating rooms, our ability to do open and endovascular surgery and single image-resourced and image-guided operating rooms.
Behzad Farivar, MD: Our goal at the University of Virginia Aortic Center is to provide high-quality, cutting-edge, comprehensive care in a multidisciplinary fashion. Care that is individualized and unique, all under one roof.
Am I a Good Candidate for a FEVAR Procedure?
Aneurysms in places where blood vessels branch off from the aorta are complex conditions. Stent-grafts aren’t the right option for everyone with these kinds of aneurysms. Your doctors and surgeons will carefully check you to see if this endovascular treatment fits your situation.
Even if you aren't a good candidate for FEVAR, we can still treat your complex aortic aneurysm with open surgery.