Use of in situ laser fenestration as a critical adjunct to prevent loss of target artery patency during complex endovascular aortic aneurysm repair

Fenestrated endovascular aortic repair (FEVAR) has revolutionized aortic aneurysm treatment. However, the integrity of the repair after FEVAR can be compromised by endoleak development and surveillance is necessary to identify such occurences.1 The development of a Type I endoleak, involving the proximal (Ia) or distal (Ib/Ic) seal zones, results in direct blood flow into the aneurysm sac and warrants intervention due to increased risk for rupture.2 The treatment of a Type I endoleak frequently involves reestablishing seal beyond the site of leakage, however the means of achieving this can be complex.