{"doi":"10.1016/j.avsg.2025.09.016","title":"Outcomes in Fenestrated and Branched Endovascular Aortic Repair Comparing Patients with Narrow Flow Lumen versus Standard Flow Lumen of the Paravisceral Aortic Segment","abstract":"BACKGROUND: Fenestrated/branched endovascular aortic repair (F/BEVAR) with commercially available devices require a paravisceral segment >20 mm. We compared commercial and physician-modified F/BEVAR outcomes in a narrowed flow lumen (NFL, <20 mm) to a standard flow lumen (SFL, ≥20 mm). METHODS: We conducted a retrospective review of F/BEVAR repairs between 2016 and 2024. Primary outcome was technical success, and secondary endpoints were target vessel stability, type 1/3 endoleaks requiring reintervention, and major adverse events (MAEs). RESULTS: A total of 136 patients underwent 138 repairs (75% male, 74 ± 10 years), 35 repairs (25%) were in NFL and 103 (75%) in SFL. Median visceral segment diameter was 24 mm (interquartile range [IQR] 19-29; 16 mm, IQR 15-18 in NFL; 28 mm, IQR 23-30 in SFL, P < 0.001). We observed 99% technical success. Mean fenestrations per repair was higher in NFL (3.1 vs. 1.5, P < 0.001), and mean branches was higher in SFL (2.1 vs. 0.7, P < 0.001). There were 24 (17%; 2 in NFL, 22 in SFL, P = 0.035) MAEs. There were nine branch vessel occlusions (three in NFL, six in SFL, P = 0.463) at a median follow-up of 516 days. Target vessel stability (86% in NFL vs. 84% in SFL, P = 0.757) and rate of reinterventions (2, 6% in NFL; 14, 14% in SFL, P = 0.209) did not differ significantly. CONCLUSION: Custom F/BEVAR offers equivalent outcomes in complex anatomy with narrowed paravisceral flow lumens compared to on-label branched and fenestrated repairs in SFLs. Early results demonstrate reasonable target vessel stability and freedom from reintervention, though additional follow-up is needed.","journal":"Annals of Vascular Surgery","year":2025,"id":575432,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9014,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":919873,"name":"Rohini J. Patel","orcid":"0000-0002-9812-6992","position":1,"is_corresponding":false},{"id":1483709,"name":"Asma Mathlouthi","orcid":null,"position":2,"is_corresponding":false},{"id":757057,"name":"Sina Zarrintan","orcid":"0000-0002-3968-0221","position":3,"is_corresponding":false},{"id":423045,"name":"Mahmoud B. Malas","orcid":null,"position":4,"is_corresponding":false},{"id":1483304,"name":"Omar Al-Nouri","orcid":"0000-0003-2380-2877","position":5,"is_corresponding":false},{"id":421925,"name":"Andrew Barleben","orcid":"0000-0003-1586-084X","position":6,"is_corresponding":false},{"id":1052799,"name":"Kathryn DiLosa","orcid":"0000-0002-1984-5711","position":0,"is_corresponding":true}],"reference_count":19,"raw_metadata":null,"created_at":"2026-07-19T02:57:48.486077Z","pmid":"40975213","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}