As an emerging technology, fenestrated and branched endovascular aneurysm repair (F/BEVAR) shows tremendous promise for managing complex aortic disease. However, pathways for building and growing a clinical program capable of successfully performing these repairs remain ill-defined. Fundamental to the process of program building is determining a clear vision of what defines success for the group and organization. First steps include decisions about the scope of the program and involvement of the US Food and Drug Administration. These decisions are interrelated with decisions about the extent of aneurysms that a program will treat and the types of devices needed to do so. The required financial resources and organizational infrastructure must be considered, with a thoughtful approach to the feasibility of such a clinical program. As for any clinical program, growth requires a track record of good clinical outcomes, patient experiences, and referring physician experiences. We describe an overview of these general considerations, while recognizing that local factors may dictate the applicability or lack thereof.
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