Synergistic Reduction of Radiation Exposure in FEVAR: Early Monocentric Outcomes Using the BeFlared Bridging Stent Using an Ultra-Low Dose (ULD) Protocol

Background Fenestrated and Branched endovascular aneurysm repair (f/bEVAR) is a technically demanding procedure associated with high fluoroscopy times and significant radiation exposure for both the patient and the operating team. Aims This study aimed to evaluate the early clinical outcomes and radiological efficiency of the new BeFlared bridging stent (Bentley, Hechingen, Germany)—which enables stent deployment and flaring in a single step using a step-balloon —in combination with the institutional "Ultra Low-Dose EVAR" protocol in use at our institution (Luzerner Kantonsspital). Methods This monocentric observational study included 15 consecutive patients treated by FEVAR. All procedures were performed using the BeFlared bridging stent. A dedicated Ultra-Low-Dose Protocol was applied in all cases, utilizing 2D-3D fusion imaging and optimal collimation to minimize exposure. Primary endpoints were technical success, early safety, and radiological parameters including Dose Area Product (DAP) and fluoroscopy time. Results Technical success was 100%. The single-step deployment mechanism of the BeFlared stent contributed, in conjuction with the Ulta-Low-Dose Protocol,to lower the median DAP. Stent-related re-interventions were not observed within the first 6 weeks. Conclusion The combination of the novel BeFlared bridging stent and a dedicated Ultra-Low-Dose Protocol proved to be safe and effective in this monocentric series (n=15). The simplified handling of the stent appears to act synergistically with radiation-sparing measures, leading to a relevant reduction in radiation exposure. Larger cohorts are required to confirm these observations.