title: Outcomes Following Limb Crossing in Endovascular Aneurysm Repairs.
abstract: BACKGROUND
  Crossing the limbs of the stent during endovascular aneurysm repair (EVAR) is often used to aid cannulation of the contralateral limb. This study assessed outcomes following the use of this technique.
  
  
  METHODS
  Retrospective review of crossed (n = 43) and uncrossed (n = 269) EVARs was performed at a tertiary vascular center over 5 years. Primary end points were graft limb occlusion (GLO), endoleak, and sac expansion rates. Indications for limb crossing were also assessed.
  
  
  RESULTS
  Two-year GLO (P = .34) and type 1 endoleak (P = .413) rates were similar between groups. Patients undergoing crossed EVAR experienced more type 2 endoleaks (P = .002) at 24 months but no increase in sac expansion rates was observed (P = .275). Thirty-day (P = .57) and late (P = .268) mortalities were similar between groups. The main indication for limb crossing was distal aortic angulation (48.8%).
  
  
  CONCLUSIONS
  Crossed EVAR does not increase the risk of GLOs or clinically significant endoleaks. Further studies are needed to determine the effect on type 2 endoleak rates.
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom nd99@le.ac.uk.
authors.forename: Nikesh
authors.initials: N
authors.lastname: Dattani
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Wild
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Sidloff
authors.affiliation: Department of Interventional Radiology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
authors.forename: Guy
authors.initials: G
authors.lastname: Fishwick
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bown
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.
authors.forename: Edward
authors.initials: E
authors.lastname: Choke
authors.affiliation: Department of Interventional Radiology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Sayers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / 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; D057867:Endoleak / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D004739:England; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D062606:Tertiary Care Centers; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: EVAR; ballerina; limb crossing; limb occlusions; outcomes