Introduction Fenestrated stent grafts are utilised to treat abdominal aortic aneurysms that are not normally amenable to conventional endovascular aortic repair. This includes scallops, fenestrations or stenting of the superior mesenteric artery. The acute angle of the SMA makes it difficult to cannulate. This study evaluated SMA outcomes after fenestrated endovascular repair and if the SMA angle contributed to rates of stenosis or occlusion. Methods: In a single centered retrospective cohort from 2010 to 2023, patients who underwent FEVAR were grouped into unstented and stented SMA. Two independent reviewers assessed patient preoperative computed tomography to compile Results: Fourty six Of the 52 aneurysms repaired by FEVAR involved scallop, fenestration or stenting (13, 5 and 28 respectively). The mean follow up was 21 months. Stenosis and occlusion of SMA occurred when the SMA was stented. 4% of SMA intervention resulted in stenosis requiring future angioplasty with no complications. 3 of 46 SMAs occluded with resultant mortality from significant bowel ischaemia. There was no SMA stent migration. The mean preoperative SMA angle was 44 degrees. SMA angle was comparable between stented and unstented groups. Conclusion: The angle of the SMA did not impact rate of occlusion or stenosis. Close surveillance of SMA stents from FEVAR is imperative to prevent morbidity, type III endoleaks and mortality.