Low-Profile Versus Standard-Profile Endograft for Thoracoabdominal and Complex Abdominal Endovascular Aortic Treatment—Multicenter Cohort Study

Objective: The introduction of low-profile stent grafts (LPSGs) has proven to be a useful option despite initial concerns. The aim of this study was to analyze and compare the outcomes of standard-profile stent grafts (SPSGs) versus LPSG in a cohort of patients treated for thoracoabdominal (TAAA) and complex abdominal (CAAA) aortic aneurysms. Methods: A multi-center cohort study based on a retrospective analysis of consecutive patients admitted for the treatment of TAAA and CAAA using fenestrated and/or branched endovascular aneurysm repair (FB-EVAR) was performed. Outcomes were compared in patients treated with LPSG versus SPSG including procedural metrics, technical success (TS), clinical complications, access-related complications, overall survival, stent-graft integrity issues, secondary interventions, sac enlargement, and primary patency of target vessels (TVs). Results: A total of 478 patients were included, with a mean age of 71.6 years (±8.96), and 80.3% were male. There were 227 TAAAs and 251 CAAAs, with a median of 4 (interquartile range [IQR]: 4-4) vessels catheterized per patient. Low-profile stent grafts were used in 137 (28.7%) patients and SPSGs in 341 (71.3%) patients. Low-profile stent grafts were more frequently used in patients with previous aortic surgery (44.9% vs 33.6%, P = .022), and the number of TVs treated differed significantly between LPSG and SPSG (4, IQR: 4-4 vs 4, IQR: 3-4; P < .001). Moderate-to-severe iliac calcification was significantly more common in the LPSG group (29.9% [n = 40] vs 18.3% [n = 61], P = .006). The tortuosity index was also higher in the LPSG group (1.35 ± 0.23) compared with in the SPSG group (1.29 ± 0.16, P = .030). Patients treated with LPSG had a similar TS rate (92.7% vs 95.0%, P = .33). There were no significant differences in postoperative complications. The median follow-up period was 6.9 months (IQR: 0.8-28.7). Regarding persistent or late endoleaks, no statistically significant differences were observed ( P = .36). Overall survival (hazard ratio [HR]: 1.06; 95% CI, 0.66-1.71; P = .78) and freedom from reintervention (HR: 1.04; 95% CI, 0.64-1.70; P = .86) were also similar between groups. Conclusion: Fenestrated and/or branched endovascular aneurysm repair with LPSG and SPSG was performed with similar rates of TS and mortality. Low-profile stent grafts were more often used in complex cases with prior aortic repairs and challenging access. Early and mid-term outcomes were comparable, with both devices showing similar safety and effectiveness profiles. Clinical Impact We performed a retrospective, multicenter cohort study including 478 patients, comparing low-profile stent grafts with standard-profile grafts in the treatment of complex aortic aneurysms. Both types of stent grafts demonstrated similar technical success, safety, and effectiveness. Low-profile endografts proved to be a viable option, particularly in more challenging cases.