Early and midterm outcomes of EVAR with 34 and 36 mm large endograft sizes: A single tertiary center study

Aim: Endovascular aneurysm repair (EVAR) has become a preferred method for accessing anatomically suitable abdominal aortic aneurysms in recent years. Advances in techniques and materials have led to the management of more challenging cases. Anatomical difficulties in the structure of the aneurysm neck can adversely affect the success of the procedure. In this study, we aimed to evaluate early and midterm outcomes in patients with wide-necked infrarenal abdominal aortic aneurysms treated with 34 mm or 36 mm EVAR endografts. Material and Methods: We evaluated infrarenal abdominal aortic aneurysms treated with 34 mm or 36 mm long EVAR allografts between January 2019 and January 2023 at Ankara Bilkent City Hospital Cardiovascular Surgery Clinic. We included and assessed patients with a neck diameter of 28 mm or greater using follow-up computed tomography angiography (CTA). We evaluated early and midterm morbidity and mortality as well as endovascular complications such as endoleak or migration. Results: A total of 58 patients with wide-neck infrarenal abdominal aortic aneurysms underwent 34 mm or 36 mm EVAR endograft deployment. There was no early mortality. The mean follow-up period was 21.7±6.4 months. Eight patients were found to have endoleaks—four had type 2 endoleaks, two had type 1b endoleaks, one had type 3 endoleak and one had type 1a endoleak. Except for type 2 endoleaks, all patients underwent endovascular reintervention. Conclusion: Our study demonstrated the successful application of 34 mm or 36 mm long endografts to patients with abdominal aortic aneurysms with a wide neck diameter. Regarding the midterm outcomes, standard EVAR procedures with large endografts are feasible and have successful outcomes.