Purpose: 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).
Methods: 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.
Results: 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).
Conclusion: No difference was found between the
crossed-limb technique and the conventional endograft position as regards short-
or midterm clinical outcomes.
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