9 Comments

• 

  Ahmed Bedeer

  
  
  

  Q1: Risks to Include in the Consent Form
  FEVAR risks …….
   Procedural risks:

  1.  Vascular injury
  2.   Endoleak
  3.   Graft migration or occlusion
  4.   Spinal cord ischemia
  5.   Renal complications: Injury to the kidneys from contrast dye (contrast-induced nephropathy) or from covering the renal arteries with the graft.

   Patient-specific risks:

  1.  Cardiac complications: a prior CABG (coronary artery bypass graft), there’s a risk
  2.  Renal failure
  3.  Cerebral vascular events
  4.  Infection

   General risks:

  1.  Bleeding or hematoma
  2.  Allergic reaction
  3.  Death

  ############
  Q2: Key Planning and Accessory Points

  1.  patient age and comorbidities
  2. aneurysm morphology: the aneurysm’s length, diameter, and angulation.
  3.  Anatomical considerations >>Renal and mesenteric artery ostia: the location, diameter, and angle of the renal arteries and superior mesenteric artery (SMA) to ensure the fenestrations on the custom graft align perfectly. >> Proximal and distal landing zones
  4. Access vessels: large enough and not too tortuous for the delivery system.
  5. Tools availability >>> Custom-made fenestrated stent graft: holes (fenestrations) or scallops + Sheaths and delivery systems + Bridging stents + Wires and catheters +  Inflation devices and balloons + Contrast injector

  ###############
  Q3: Key Steps of the Procedure
  The procedure is a multi-step process that requires precision and meticulous execution for 10 steps of planning……

  1. Centerline placement for accurate measuring 
  2. marking the center of visceral artery origen 
  3. Determining tha proximal landing zones site with a minimum of 20 mm parallel walled arterial segment free for mural disease 
  4. Measuring the diameter of landing zones at 3 sites and the largest of them to be oversized bt 10_15%
  5. Measuring the length from the proximal edge of the graft to the center of each branch vessel 
  6. Measuring target artery clock orientation
  7. choose the proximal fenestrated component
  8. indicted the desine scalloping or fenestrations
  9. Choose the distal bifurcated component
  10. choose the iliac limb

  And 5 steps of applying…….

  1.  Access: The procedure begins with gaining femoral artery access. Typically, both femoral arteries are accessed percutaneously or via a small incision.
  2. Guide wire Placement: A guidewire is advanced from the femoral artery, up into the aorta, and positioned in a safe location, often in the ascending aorta. This acts as a rail for the delivery system.
  3. Graft Deployment: The main fenestrated stent graft is deployed. The delivery system is carefully navigated to the correct position, and the graft is released. The key here is to align the fenestrations of the graft with the patient’s renal and SMA arteries. This often involves specific markers on the graft and fluoroscopy.
  4.  Bridging Stent Cannulation and Deployment: Once the main graft is in place, the renal and SMA arteries are cannulated. A catheter and wire are used to navigate through the fenestrations into each target vessel. Bridging stents are then deployed within these vessels, extending from the main graft into the target arteries. This secures the connection and prevents leaks.
  5.  Final Check Angiogram: After all components are in place, a final angiogram is performed. This involves injecting contrast dye and taking images to confirm that the stent graft is correctly positioned, the visceral arteries are patent, and there are no endoleaks or other complications. If any issues are detected, further ballooning or stent placement may be necessary.

  August 16, 2025 at 1:07 pm    Log in to Reply
• 

  Ahmed Said

  
  
  

  A1
  UP to death
  MI
  Bowel ischemia
  Spinal cord ischemia
  Endo leak
  …..
  A2
  Age
  Aneurysm size
  Comorbiditis
  Anatomical concidriations
  Acesses
  …….
  A3
  Central line into aorta
  Place marker for each vesral artery, like renal and SMA
  Proximal landing zone of graft is over sizing by 10%
  The clock face position of each target artery chose the proximal fenestrated
  The distal biforcated body
  Iliac limbs

  August 12, 2025 at 2:36 am    Log in to Reply
• 

  Hesham Rozza

  
  
  

  A1 risks
  death
  MI -AKI -bowel ischemia -spinal cord ischemia -ll ischemia
  stroke – acsess complications like pseudoaneurysm and hematoma
  endoleak

  A2 factors
  patient age
  comorbidities
  aneurysm size
  anatomical consideration and viratation
  acsess
  proximal and distal landing zone

  A3 key steps

  starts with central line placement into the aorta
  place markers at the origin of each visceral artery — like renals, SMA
  the proximal landing zone of the graft. with oversizing the graft by about 10%.
  the clock-face position of each target artery
  choose the proximal fenestrated component,
  the distal bifurcated body, and finally the iliac limbs.

  July 25, 2025 at 10:55 pm    Log in to Reply
• 

  Ahmed Nasr Mohammed Abdelfattah Ahmed Osman

  
  
  

  Q1:
  Complications can include MI, renal failure, or stroke. Also things like endoleak, limb thrombosis, or stent migration. On top of that, there’s risk of wound infection and even secondary hemorrhage post-op.

  ⸻

  Q2:
  The decision depends on multiple factors — patient’s age, size of the aneurysm, his comorbidities like HTN, DM, IHD, etc. Also anatomical factors like neck length, tortuosity, and whether the access vessels are suitable or not.

  ⸻

  Q3:
  It starts with central line placement into the aorta, then we place markers at the origin of each visceral artery — like renals, SMA — and also at the proximal landing zone of the graft. We usually oversize the graft by about 10%. Need to know the clock-face position of each target artery, then choose the proximal fenestrated component, the distal bifurcated body, and finally the iliac limbs.

  July 23, 2025 at 11:50 am    Log in to Reply
• 

  Malek Abdelraouf Moustafa Ahmed Eladawi

  
  
  

  Q1:
  MI, Renal failure, stroke
  endoleak, limb thrombosis or stent migration
  wound infection and secondary hemorrahge
  Q2:
  age of the patient and aneurysmal size and his medical comorbidities and anatomical considerations and the access vessel requirements
  Q3:
  10 steps central line placement of the aorta and marker placement in the center of each of the visceral artery origin and proximal end of the device and 10% oversizing and target artery clock position and choose the proximal fenestration component and distal bifurcated component and iliac limb

  July 19, 2025 at 6:45 pm    Log in to Reply
• 

  mahmoud mahdy

  
  
  

  A1..
  Intra operative type 1A or B endo leak
  Early post op complications
  *.Access sites complications as hematoma and pseudoaneurysm or wound infection
  Early graft thrombosis
  *. General cardiac and respiratory complication
  Ranal failure

  Late complications as
  Endoleake . Graft migration or thrombosis

  Q2..
  > access sites (diameter ,torsousity,calcification and thrombosis)
  > Landing zones at least 20mm healthy parallel wall of arterial segment free from thrombus of calcification

  > Clock Orientation of branch vessels and their diameters

  Q3.
  10 steps of planning.
  1. Centerline placement for accurate measuring

  2.marking the center of visceral artery origen

  3. Determining tha proximal landing zones site with a minimum of 20 mm parallel walled arterial segment free for m disease

  4. Measuring the diameter of landing zones at 3 sites and the largest of them to be oversized bt 10_15%

  5. Measuring the length from the proximal edge of the graft to the center of each branch vessel

  6. Measuring target artery clock orientation
  7.. chose the proximal fenestrated component
  8 indicted the desine scalloping or fenestrations
  9 . Choose the distal bifurcated component
  10.. choosing the iliac climb

  July 19, 2025 at 11:19 am    Log in to Reply
  • 

    Tamer Fouad

    
    
    

    Thanks a lot for your answer
    I would add bowel schema and spinal cord schema to the mentioned possible complications

    July 19, 2025 at 4:44 pm    Log in to Reply
• 

  Reda Mansy

  
  
  

  A1:
  General MI RF Resp F Stroke DVT
  Local Early
  Endoleak thrombosis limb occlusion rupture colonic limb renal ischemia CIN access site complication

  Local late
  Infection migration delayed endoleak endotension

  A2:
  Patient selection age comorbidities

  Anatomical considerations the neck proximal landing zone at least 2 cm parallel disease free and the distal landing zone along with the access site and the whole aorta as well with branch clock orientation for good accurate planning

  A3:
  10steps for the FEVAR planning

  Central line placement

  Marking og each br origin

  Prox landing zone

  Measurements of diameters select tha largest of 3 with 10-15% oversizing

  The same for lengths from PLZ to each br origin and to bifurcation

  Target vessel clockwise orientation

  Choose the proximal fenestsration component and decide if scalop or fenestration along with the bifurcated body graft and iliac limbs

  July 15, 2025 at 3:23 pm    Log in to Reply
  • 

    Tamer Fouad

    
    
    

    Well done
    very thorough method

    July 17, 2025 at 5:25 pm    Log in to Reply