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Durable Limb Patency After EVAR Using Parallel Excluder Limbs for Narrow Distal Aortas: A Retrospective Cohort Study
Takuma Kobayashi1, Hidetake Kawajiri1, Keiichi Kanda1
1Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Insights
Endovascular aneurysm repair (EVAR) with Gore Excluder iliac limbs in narrow distal aortas (<18 mm) showed no limb occlusions or aortic deaths. This approach offers favorable midterm limb patency for high-risk patients.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Aortic Aneurysm Repair
Background:
- Narrow distal aortas (<18 mm) pose risks for limb patency loss and graft complications in endovascular aneurysm repair (EVAR).
- Assessing outcomes of EVAR with specific iliac limbs in patients with challenging distal aortic anatomy is crucial.
Purpose of the Study:
- To evaluate limb occlusion-free survival and patency after EVAR using bilateral Gore Excluder iliac limbs in patients with narrow distal aortas (<18 mm).
Main Methods:
- Retrospective cohort study of 87 patients with infrarenal abdominal aortic aneurysms and distal aortic diameters <18 mm.
- Bilateral Gore Excluder iliac limbs were deployed in the narrow distal aorta.
- Primary endpoint: limb occlusion-free survival; Secondary endpoints: patency, reintervention, mortality, and ABI.
Main Results:
- Median follow-up of 2.6 years with no observed limb occlusions or aortic-related deaths.
- No limb-related reinterventions were required.
- Midterm cross-sectional area increased, and ankle-brachial index (ABI) remained stable.
Conclusions:
- EVAR with bilateral Gore Excluder iliac limbs demonstrates favorable midterm limb patency in narrow distal aortas (<18 mm).
- This strategy appears feasible and safe for patients with narrow distal aortas, traditionally considered high-risk.
- Findings support the use of this EVAR technique in complex aortic anatomies.
Background:
A narrow distal aorta is a recognized risk factor for limb patency loss and graft-related complications following endovascular aneurysm repair (EVAR). This study aimed to evaluate limb occlusion-free survival and patency outcomes following EVAR using bilateral Gore Excluder iliac limbs in patients with distal aortic diameters <18 mm.
Methods:
In this single-center, retrospective cohort study, 87 patients with infrarenal abdominal aortic aneurysms and distal aortic diameters <18 mm measured immediately proximal to the aortic bifurcation, who underwent EVAR between April 2013 and January 2024, were included. Bilateral Gore Excluder limbs were deployed within the narrow distal aorta in all cases. The primary endpoint was limb occlusion-free survival. Secondary endpoints included primary patency, limb-related reintervention, aortic-related mortality, changes in cross-sectional area, and the ankle-brachial index (ABI) over time.
Results:
The median follow-up duration was 2.6 years (range: 0.01-10.1 years). No limb occlusions or aortic-related deaths were observed during follow-up in this cohort. Limb-related reinterventions were not required. Cross-sectional area increased at midterm follow-up. ABI values remained stable between limbs during early and midterm follow-up.
Conclusion:
EVAR using bilateral Gore Excluder iliac limbs in distal aortas <18 mm was associated with favorable midterm limb patency, with no limb occlusions or aortic-related mortality observed during midterm follow-up in this cohort.Clinical ImpactEndovascular repair using parallel Gore Excluder limbs may represent a feasible treatment option for patients with narrow distal aortas, a group traditionally considered at high risk for standard EVAR. This study reports midterm clinical outcomes in patients treated with this strategy, with no limb occlusions or aortic-related deaths observed during follow-up. By confirming durable patency and procedural safety in anatomically complex cases, these findings provide clinical insight into the use of this strategy in patients with narrow distal aortas in contemporary clinical practice.
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