Clinical outcomes after crossed-limb vs. conventional endograft configuration in endovascular AAA repair

To report a case controlled analysis of endovascular aneurysm repair (EVAR) outcomes using the crossed-limb (CxL) endovascular configuration vs. the straight-limb configuration (SLC).

From January 2007 to July 2012, 27 patients (25 men; mean age 73.7±7.2 years, range 53-82) were treated by EVAR with the CxL technique. These patients were matched anatomically with 27 patients (27 men; mean age 72.4±7.4 years, range 52-86) who underwent EVAR using the same endograft and the standard SLC within a ±6-month period. Primary outcome measures included technical and clinical success and freedom from graft limb thrombosis, any type of endoleak, early or late secondary interventions, and aneurysm-related death estimated using the Kaplan-Meier method.

The median follow-up periods for the CxL and SLC groups were 29.9 (range 6-54) and 33.5 (range 6-59) months, respectively (p=0.81). The technical success rate was 100% in both groups, but mean procedure times were significantly longer in the CxL group (116.3 vs. 90.7 minutes, p=0.035). Twelve intraoperative endoleaks (3 each for types Ia, Ib, II, and IV) occurred but without any difference between groups (p=0.51). One CxL group patient died in the early postoperative period (aneurysm-related) and another had an early graft limb thrombosis. One late type Ib intraoperative endoleak was recorded in the SLC group (p=0.51). For the CxL vs. SLC groups, the 1-year rates for freedom from endograft limb thrombosis (94% vs. 96%), any type of endoleak (96% vs. 96%), early or late reintervention (94% vs. 96%), and aneurysm-related death (94% vs. 96%) were not significantly different. Respective values at 36 months were 82% vs. 82%, 85% vs. 84%, 81% vs. 78%, and 83% vs. 84% (p>0.05). Clinical success rates at 12 months for the CxL and SLC groups were 91% and 100% (p>0.05), respectively, whereas at 36 months, the rates were 83% and 90% (p>0.05).

No difference was found between the crossed-limb technique and the conventional endograft position as regards short- or midterm clinical outcomes.