Durable Limb Patency After EVAR Using Parallel Excluder Limbs for Narrow Distal Aortas: A Retrospective Cohort Study

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.