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Customized Fenestrated-Branched Endovascular Repairs Expand Options for Complex Abdominal Aortic Aneurysms

February 13, 2024
Customized Fenestrated-Branched Endovascular Repairs 1

Left: Physician-modified endograft with four fenestrations

Right: Physician-modified endograft with two branches and two fenestrations


Orlando Health Heart and Vascular Institute recently expanded its complex endovascular aortic program, adding customized fenestrated-branched endovascular aortic repair (F/BEVAR) with the ability to create physician-modified endografts (PMEG) on site.

A fenestration in the stent-graft allows maintained flow to the renal arteries while permitting treatment of juxtarenal or thoracoabdominal aortic aneurysms not amenable to standard EVAR. Fenestrated-branched endovascular repair utilizes either an off-the-shelf company manufactured device (CMD) or a patient-specific CMD. Both of these options are limited to a handful of sites around the country through a special exemption from the FDA. For institutions that do not have access to these, PMEG provides another alternative.

Aleem Mirza, MD
Aleem Mirza, MD

“We now have the ability at Orlando Health, using the same techniques as a manufacturer, to make any device needed to fix any aneurysms and morphology within reason at the time of operation,” says Aleem Mirza, MD, a board-certified vascular surgeon at Orlando Health Heart and Vascular Institute with expertise in the treatment of complex and thoracoabdominal aortic aneurysms.

Dr. Mirza trained at Mayo Clinic Rochester with Dr. Gustavo S. Oderich, a pioneer and leader in fenestrated-branched repair. In addition to utilizing PMEG to repair complex aortic aneurysms, Dr. Mirza has participated in several trials using investigational manufactured devices.

Customized Fenestrated-Branched Endovascular Repairs 2

Left: Dr. Aleem Mirza and Dr. Edgar Guzman creating fenestrations for a patient-specific endograft

Right: Dr. Mirza creating a patient-specific fenestrated stent-graft to repair a complex aortic aneurysm


In January 2024, the Orlando Health team successfully repaired the region’s first two cases of thoracoabdominal aneurysms with minimally invasive endovascular technology.

“We completely fabricated a customized device from scratch on-site to fix the aneurysms for these patients,” says Dr. Mirza. “Both cases were prohibitive — anatomically and physiologically higher risk. We customized the device for each of them based on their individual anatomy and repaired them.”

Customized Fenestrated-Branched Endovascular Repairs 3
Angiogram demonstrating endovascular repair of an extent I thoracoabdominal aortic aneurysm

F/BEVAR grafts create more durable repairs and offer the ability to customize a stent to fix failed repairs as well. “It’s a technique we can use to fix multiple problems for patients, whether their complex aneurysms are elective or an urgent, emergent repair,” says Dr. Mirza. “This ability expands selectivity and customization for each patient.”

Orlando Health Heart and Vascular Institute is a national Top 50 program renowned for cardiovascular innovation, exemplary heart care, advanced research and education. Board-certified cardiovascular providers are highly skilled in leading technologies, including innovative diagnostic services, nonsurgical and minimally invasive treatment options.

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