Practical points of attention beyond instructions for use with the Zenith fenestrated stent graft

Fenestrated stent grafting for endovascular repair (F-EVAR) aims to treat patients with abdominal aortic aneurysms that are unsuitable for standard EVAR because of a short or absent infrarenal neck. F-EVAR has been used initially in patients with higher surgical risk with pararenal abdominal aortic aneurysms, but F-EVAR is now increasingly considered a treatment alternative to open surgery in anatomically suitable patients. F-EVAR has benefitted from ongoing technical refinements and accumulating clinical experience but remains a relatively complex procedure. Correct indication, accurate preoperative planning, and meticulous execution are the key to long-term success. Considering the growing interest in F-EVAR worldwide, including the United States, we discuss current indications and provide advice for planning and technical execution on the basis of the senior authors' 13 years of experience.