Endovascular aortic repair with the custom-made cook fenestrated device for the treatment of complex abdominal aortic aneurysms

BackgroundFenestrated endovascular aneurysm repair (FEVAR) has become an essential option for the treatment of complex abdominal aortic aneurysms (AAA). While technological advances and growing operator experience have expanded its applicability, outcomes remain heterogeneous across centers and patient subsets. Evaluating real-world results is crucial to better define the effectiveness, safety, and durability of FEVAR in current practice.MethodsThis is a single-center, retrospective, observational study. Consecutive patients treated with FEVAR for complex AAA with a custom-made Cook device from January 2015 to October 2025 were included. Outcomes accessed included technical success, early major systemic complications, overall survival, freedom from reinterventions, target vessel instability, endoleaks, and sac expansion.ResultsSixty-four consecutive patients were treated with FEVAR Cook, of which 23 (35.9%) for juxtarenal AAA, 35 (54.7%) pararenal AAA and 6 (9.4%) thoraco-abdominal type IV aortic aneurysm. All but three patients were treated electively (95.3%). Two hundred twenty-two target vessels were successfully cannulated and treated with a bridging stent. Technical success was 98.4%. Early major systemic complications rate was 14.1%. Median follow-up was 29.5 months (IQR 47). Overall survival estimates at 1 and 4 years were 86.9% and 71.3%, respectively. Estimates at 4 years of freedom from reinterventions and target vessel instability were 90.9% and 93.8%, respectively. Freedom from type I/Ic and III/IIIc endoleak was 95.3% at 4 years. Sac regression, stability, and expansion at follow-up occurred in 29.5%, 63.9%, and 6.6%, respectively.ConclusionsFEVAR emerges as an appropriate and effective treatment option for complex aortic aneurysms. In our experience, the procedure provides high technical success and durable target-vessel preservation, with very satisfactory outcomes even at mid- to long-term follow-up.