title: Clinical outcomes after crossed-limb vs. conventional endograft configuration in endovascular AAA repair.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  No difference was found between the crossed-limb technique and the conventional endograft position as regards short- or midterm clinical outcomes.
authors: 1 Department of Vascular Surgery, "Demokritus" University of Thrace, University General Hospital of Alexandroupolis, Greece.
authors: George S
authors: GS
authors: Georgiadis
authors: Efstratios I
authors: EI
authors: Georgakarakos
authors: George A
authors: GA
authors: Antoniou
authors: George
authors: G
authors: Trellopoulos
authors: Christos
authors: C
authors: Argyriou
authors: Evagelos S
authors: ES
authors: Nikolopoulos
authors: Dimitrios
authors: D
authors: Charalampidis
authors: Nikolaos G
authors: NG
authors: Schoretsanitis
authors: Miltos K
authors: MK
authors: Lazarides
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D057867:Endoleak / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome