Long-term Results of Low-profile Stent Grafts for Treatment of Infrarenal Aortic Aneurysms: Results from a Retrospective Multicenter Registry

ABSTRACT OBJECTIVE In recent years, manufacturers have developed new stent grafts with lower profiles to increase the endovascular aneurysm repair applicability. As reported by the current ESVS guidelines, long-term evaluation of such low-profile platforms is strongly recommended. This study aims to report outcomes beyond five years from a multicenter registry, including a real-world cohort of patients electively treated with low-profile stent grafts. METHODS A retrospective data collection of patients who had undergone elective implantation of low profile endograft ≤16 Fr. (Zenith LP, Ovation, Incraft) was performed in 9 centers. The primary aim was a long-term primary clinical success. Secondary aims were survival rate, freedom from AAA-related death, freedom from type I-III endoleak, limb patency, and freedom from all reinterventions. The Kaplan-Meier curves were stratified for investigative devices. A multivariate analysis evaluated predictors of primary clinical success and reintervention rate. RESULTS A total of 619 patients were enrolled (Ovation 373, Incraft 111, Zenith LP 135), with a mean follow-up of 56.8±22.8 months. The overall primary and the secondary clinical success rate at 8 years was 72.1% and 93.8%, respectively. At 8 years, overall survival was 53.2%, freedom from AAA-related death 94.4%, freedom from reintervention 74%, freedom from type I/III endoleak 86.9%, and limb patency 90.4%. A significant worse primary clinical success of the Zenith LP was recorded as dependent on more limb-related events. No differences between platforms were registered in the rate of AAA-related deaths, open conversion, sac enlargement, and type I/III endoleaks (p=0.26). Multivariate analysis identified Iliac tortuosity (HR 2.053) and Zenith LP (HR 3.818) as significant independent predictors of clinical failure and reintervention. CONCLUSION Low-profile stent grafts have acceptable long-term outcomes. Overall survival and AAA-related death were in line with those reported for traditional devices. Long-term surveillance and reintervention, when necessary, remain crucial to guarantee durability.