When previous FEVAR complicates the picture

A 72-year-old man with a history of fenestrated endovascular aortic repair (FEVAR) presents with abdominal symptoms and multiple comorbidities.

What initially appears to be a non-specific clinical picture soon evolves into a complex vascular challenge, where previous aortic repair plays a pivotal role in determining the treatment strategy.

Faced with several possible therapeutic options, what would you choose?

Wassim Mansour

Sapienza Università di Roma - Policlinico Umberto I di Roma

Associate Professor in Vascular Surgery - Vascular Surgeon

Part I - Case presentation

Clinical presentation

A 72-year-old man with significant cardiovascular comorbidities presented with non-specific abdominal symptoms in the context of previous complex aortic repair.

Medical history:

Systemic hypertension
Chronic ischaemic cardiomyopathy
Atrial fibrillation
Mild renal insufficiency
Myelodysplasia

Previous aortic intervention:

FEVAR performed in 2023
including four bridging stents: for SMA + CT + 1 RRA + 2 LRA (scallop for CT)

Recent clinical presentation:

Assessment 20 days earlier for abdominal constipation and asthenia