This study clearly explains that most manufacturers recommend a 10% to 20% degree of endograft oversizing, the optimal degree and impact of endograft oversizing remain unclear. Therefore, we examined the influence of the degree of endograft oversizing on mortality, late reinterventions, and rupture rates after endovascular aneurysm repair (EVAR).

We identified patients undergoing elective EVAR between 2012 and 2016 in the Vascular Quality Initiative linked to Medicare claims for long-term outcomes. We calculated the degree of oversizing by dividing the endograft diameter by the preoperative outer aortic wall diameter of the aneurysm neck and stratified oversizing into <10%, 10% to 20%, and >20%. Two-year reinterventions, rupture rates, and survival were assessed using Kaplan-Meier estimations. We included 4595 patients; 20% had oversizing below 10%, 34% between 10% and 20%, and 46% above 20%. Patients with oversizing above 20% were more often female (23% vs 16%; P < .001) and more often had any hostile neck characteristic (39% vs 28%; P < .001). Also, patients with oversizing below 10% were more likely to have any hostile neck characteristic (46% vs 28%; P < .001). Patients with oversizing above 20% had higher 2-year reintervention rates.

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