Contrary to previous smaller reports of T2ELs and DU surveillance, parameters such as IFV did not correlate with increased post-EVAR sac diameter. The presence of multiple T2ELs and bidirectional SDW may be the strongest factors predictive of increased sac diameter.

Balloon angioplasty of PAS resulted in acceptable 2-year assisted primary patency rate of almost 60%. Endovascular intervention avoided repeat incisions in scarred groins, higher rates of nerve injury and infection, significant blood loss, and longer length of hospital stays. We recommend that balloon angioplasty of PAS be attempted before resorting to surgical intervention, especially in cases of hostile anastomotic wounds.

98.8%]) and OSR (100%, P Ͼ .05). The 5-year all-cause survival was significantly reduced in the EVAR group (50.4%, 95% CI, 34%-66%.) vs OSR (80.4%, [95% CI, 66.9%-89.5%; P ϭ .0279; h, 0.34 [95% CI, 0.12-0.94]). However, none of the deaths in the EVAR group were aneurysmrelated. The 30-day morbidity (P Ͻ .0001), length of hospital stay (P Ͻ .0001), 5-year quality-adjusted time spent without symptoms of disease and toxicity of treatment (P Ͻ .01), and cost per QALY (P Ͻ .01) were all significantly reduced with EVAR compared with OSR.Conclusions: Endografts can be effectively used to treat difficult pararenal AAAs, with enhanced long-term aneurysm-related survival, cost-effectiveness, and quality of life, and with significantly reduced perioperative morbidity, mortality, and waiting time from diagnosis to treatment.