Fenestrated Endovascular Aortic Repair (FEVAR) and Physician-Modified Endograft (PMEG)
Key takeaways
What it is: FEVAR and PMEG are minimally invasive endovascular repair surgeries to fix complex aortic aneurysms using a specially made stent.
Why it’s special: The stent has "windows" (fenestrations) that allow blood to flow to vital organs like the kidneys and stomach.
Who it’s for: Aortic disease patients with aneurysms located too close to major branch arteries for a standard repair.
Benefits: Smaller incisions, less pain, and a faster recovery compared to traditional open surgery.
Recovery: Expect a three to seven day hospital stay, including time in the CVICU and specific "laying flat" requirements.
Lifelong Care: Patients require lifelong follow-up with regular CT scans to ensure the stent remains secure and the aneurysm does not grow.
What is FEVAR/PMEG?
A FEVAR/PMEG is an advanced technique to treat a complex abdominal aortic aneurysm. An aneurysm is a weak, bulging spot in the aorta, the body's main blood vessel.
Most aneurysms can be fixed with a standard stent-graft, which is a fabric-covered tube. However, some aneurysms are located right where important arteries branch off to necessary organs such as the kidneys, liver and intestines. A standard stent would block blood flow to these organs.
"Fenestrated" means the stent has small, custom-placed holes or "windows." These holes are designed to line up perfectly with your unique anatomy, allowing the surgeon to repair the aneurysm while keeping blood flowing to your vital organs. FEVAR/PMEG is a great example of the truly individualized care that the UF Health Aortic Disease Center offers our patients.
Who is a candidate for FEVAR/PMEG?
FEVAR/PMEG is specifically designed for patients whose aneurysms are located near the branch arteries. In the past, these patients usually required major open-heart or abdominal surgery.
Your doctor may recommend a fenestrated endovascular aneurysm repair if:
Your aneurysm is too close to the kidney or gut arteries for a standard stent.
You are considered high risk for traditional open surgery due to age or other health conditions.
Your anatomy is uniquely shaped, requiring a custom-fit solution.
How a FEVAR/PMEG procedure works
The FEVAR/PMEG procedure requires surgeons with a truly elite level of expertise. It is a team effort that involves highly skilled vascular surgeons, state-of-the-art imaging and other advanced technology.
Custom Mapping: Surgeons use high-resolution CT scans to create a 3D map of your aorta.
Manufacturing: A medical device company uses this map to build a stent-graft specifically for your body. Each hole is placed exactly where your branch arteries start.
The Procedure: Through tiny incisions in the groin, the surgeon uses a thin catheter to slide the folded stent into the aorta.
Placement: Using X-ray guidance, the surgeon aligns the "windows" in the stent with your arteries and expands the graft, sealing off the aneurysm.
After a FEVAR/PMEG procedure
Following your FEVAR/PMEG procedure, you will be taken to the Cardiovascular Intensive Care Unit (CVICU). Once you are stable, typically in a day or two, you will be moved to a regular medical-surgical unit.
Bed Rest: You will be asked to lay flat in bed until your spinal drain (used to protect your spinal cord during the procedure) is removed. This usually happens 24 to 48 hours after surgery.
Hospital Stay: A typical stay lasts between three to seven days, depending on the complexity of your repair. You will be cleared to go home once you can walk and tolerate a normal diet.
Risks to consider for a FEVAR/PMEG
While FEVAR/PMEG is less invasive than open vascular surgery, it is a major procedure. Risks specific to this operation include:
Weakness or complete paralysis of the legs.
Temporary kidney issues caused by the dye (contrast) used during imaging.
Problems with blood flow to the intestines.
Endoleaks: A poor seal where blood still leaks into the aneurysm.
Bleeding or infection at the groin incision.
Post-operative care at home after a FEVAR/PMEG
Once you are home, following these guidelines is essential for a safe recovery:
Lifting Limits: For the first two weeks, do not lift anything heavier than 5 to 10 pounds.
Medications: If you are taking narcotic pain medications, do not drive or operate machinery.
Incision Care: You may shower and let soap and water run over your incisions, but you must pat them dry. Do not soak in a tub or pool.
Daily Checks: Check your groin incisions daily for redness, warmth, or swelling.
Contact your doctor immediately if you experience shortness of breath, chest pain, or sudden changes in the strength or color of your legs.
Lifelong follow-up and surveillance for FEVAR/PMEG patients
Over time, stent grafts can shift or migrate, kink, or develop leaks. You may not feel any symptoms if this happens. Because of this, you will need lifelong routine surveillance.
Your follow-up schedule will typically include:
One Month: First follow-up and CT scan.
Six Months: Second follow-up and CT scan.
Yearly: Annual checkups and imaging for the rest of your life.
These scans allow your UF Health team to monitor the "remodeling" of your aorta and ensure the graft is working perfectly. If an endoleak is found, it can often be fixed with a simple, minimally invasive treatment before it leads to a rupture.
Frequently asked questions
How long does it take to get a custom FEVAR/PMEG graft?
Because each device is custom-made to match your 3D CT scans, it generally takes 4 to 6 weeks for the manufacturer to build and deliver your specific graft.
Can a FEVAR stent fail?
While rare, stents can develop "endoleaks" or move slightly. This is why regular CT scans are required. If a problem is caught early, it is usually very easy to fix.
When can I return to work?
This depends on your specific job and the complexity of your surgery. Most patients are cleared to return to work after their one-month follow-up appointment.
Is FEVAR/PMEG better than open surgical repair?
For many patients, yes. FEVAR/PMEG offers a much faster recovery time and a lower risk of complications like infection or heavy bleeding. However, not every patient's anatomy is right for FEVAR/PMEG. Your surgeon will discuss which option is safest for you.
Why choose the UF Health Aortic Disease Center?
The UF Health Aortic Disease Center is one of only a few centers in the country with the expertise to perform FEVAR/PMEG. Our vascular surgeons are not only highly skilled but are also trailblazers in the field, often participating in clinical trials for the next generation of custom-made devices. We offer a patient-first approach, ensuring your custom stent is a perfect fit for your life and health.
To schedule a consultation or learn more about complex aortic repair, please contact the UF Health Aortic Disease Center by calling (352) 273-5494.
This entry was written by Gabrielle Massari, Marketing Content Writer, and reviewed for accuracy by Eric Jeng, MD. Generative AI was leveraged as part of the content creation process.