Redo Fenestrated/Branched EVAR After Prior Complex Endovascular Aortic Repair: A Narrative Review

BACKGROUND: Although fenestrated and branched EVAR (f/bEVAR) is increasingly the mainstay for managing juxtarenal and thoracoabdominal aortic aneurysms, long- term surveillance shows a growing need for reintervention because of complications such as type I and III endoleaks, graft migration, and target vessel instability, which may necessitate redo f/bEVAR. This review aims to summarize the current literature on redo f/bEVAR for complex aortic aneurysms. METHODS: A narrative review of English- language studies published from 2010 through March 2025 was conducted using PubMed and Scopus. Selected articles included registry data, case reports, and clinical series detailing the indications, techniques, and outcomes of redo f/bEVAR. Relevant procedural experience was also incorporated to highlight evolving strategies. RESULTS: The most common indications for redo f/bEVAR were type Ia and III endoleaks, reported in 2- 5% of patients, typically 3- 5 years after the index procedure. Technical success rates ranged from 83% to 100%, with low perioperative mortality. Redo procedures were associated with prolonged operative times and increased radiation exposure, but midterm results were favorable, with high secondary clinical success rates and aneurysm sac stability or regression in most cases. CONCLUSION: Redo f/bEVAR is a feasible and increasingly necessary approach for managing late complications in selected patients after failed f/bEVAR. Its success depends on individualized planning, advanced imaging, and technical expertise. Further studies are needed to guide device selection, predict long- term durability, and define optimal strategies for complex reinterventions.