Thirteen Years Data of Low-Profile Aortic Endografts for Endovascular Aneurysm Repair: A Systematic Review and Meta-Analysis

Abstract

Background:

The objective of this systematic review was to provide evidence-based data regarding the safety and efficacy of the low-profile endografts (LPEGs) for abdominal aortic aneurysms.

Methods:

A systematic search of all the literature reported until April 2025 was performed according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. The main outcomes were technical success, mortality, limb occlusions, reintervention, type I endoleak and adjunctive procedures.

Results:

A total of 2744 study titles were identified by the initial search strategy, of which 28 studies were considered eligible for inclusion in the present meta-analysis. A total of 1585 patients (88%, men) were identified among the eligible studies. The overall technical success rate was 97.1% (95% confidence interval [CI] 95.4-98.2%; I²=68%) (InCraft=94.5%; Zenith=97.7%; Ovation=98.7%; Minos=94.2%, Altura=98.8%) while the 30-day mortality rate was 0.9% (95% CI 0.6%-1.3%; I²=0%, p=0.95). The 30-day limb occlusion rate was 1.5% (95% CI 1.0-2.4%; I²=39%) (InCraft=1.9%; Zenith=1.5%; Ovation=1.2%; Minos=1.1%, Altura=1.2%) in the early period while during the follow-up, the limb occlusion rate was 4.1% (95% CI 2.9%-5.7%; I²=69%) (InCraft=5.1%; Zenith=6.0%; Ovation=2.3%; Minos=1.7%, Altura=1.8%). The 30-day reintervention rate was 2.7% (95% CI 1.8-4.0%; I²=57%) (Incraft=1.4%; Zenith=3.4%; Ovation=3.1%; Minos=1.7%; Altura=3.9%) while the pooled late reintervention rate was 7.6% (95% CI 5.3-10.8%; I²=89%) (InCraft=8.6%; Zenith=10.6%; Ovation=6.8%; Minos=3.4%, Altura=5.9%). The incidence of 30-day type Ia endoleak was 2.6% (95% CI 1.5-4.6%; I²=84%) (InCraft=5.9%; Zenith=1.2%; Ovation=2.0%; Minos=1.1%, Altura=1.2%) and 1.5% (95% CI 1.0-2.3%; I²=37%) (InCraft=1.0%; Zenith=1.4%; Ovation=1.6%; Minos=1.7%, Altura=1.2%) in the late period. The overall 30-day adjunctive procedures was 12.2% (95% CI 8.8-16.7%; I²=90%)(Incraft=13.6%; Zenith=24.7%; Ovation=3.3%; Minos=15.4%; Altura=3.0%).

Conclusions:

The present findings support the use of LPEGs in patients eligible for endovascular aortic aneurysm repair especially with hostile iliac anatomies. Limb-related complications remain the Achilles heel for certain devices, underscoring the need for strict postoperative surveillance. Further studies are warranted to investigate the underlying causes of these complications and to assess the long-term durability of these devices.

Clinical Impact

This study provides comprehensive data on the use of low-profile endografts (LPEGs) for the repair of abdominal aortic aneurysms (AAA). Despite significant advances in endograft technology, access-related challenges and limb complications remain among the most common adverse events associated with endovascular aneurysm repair (EVAR). The introduction of LPEGs was intended to broaden the applicability of EVAR to patients with complex anatomies, including narrow or tortuous access vessels and short or angulated aneurysm necks. The objective of this systematic review was to evaluate thirteen years of data on the safety and efficacy of LPEGs in AAA repair. Overall, the results support the use of LPEGs in appropriately selected patients, particularly those with hostile iliac anatomies. However, limb-related complications persist as the Achilles’ heel of certain devices, highlighting the importance of vigilant postoperative surveillance. Further research is needed to elucidate the mechanisms behind these complications and to assess the long-term durability of these devices.