Diagnostic and Prognostic Implications of Ultra-Low-Profile INCRAFT and Ovation Endografts: Long-Term Follow-Up in a Single-Center Experience

Background/Objectives: Ultra-low-profile (ULP) endografts have expanded the applicability of endovascular aneurysm repair (EVAR) in patients with challenging aortoiliac anatomy and narrow access vessels. However, direct long-term comparisons between different ULP devices remain limited. This study aimed to compare mid- to long-term outcomes of the INCRAFT and Ovation endografts in a single-center experience. Methods: This retrospective single-center study included 102 patients (45 Ovation, 57 INCRAFT) with a median follow-up exceeding 60 months. We retrospectively analyzed 102 consecutive patients undergoing elective EVAR with ULP devices between January 2011 and December 2019. Forty-five patients were treated with Ovation and 57 with INCRAFT. The primary endpoint was technical success. Secondary endpoints included survival, reintervention, endoleak, and device-related complications. Statistical comparisons were performed using Student’s t-test and Fisher’s exact test. Results: Primary technical success was achieved in all cases. The Ovation group exhibited more complex proximal neck anatomy, including greater thrombus involvement (47.4% vs. 12.7%, p < 0.001). Post-implantation syndrome occurred more frequently with INCRAFT (14% vs. 0%, p = 0.009). No significant differences were observed in endoleak, major adverse events, or total reintervention. Long-term mortality was higher in the Ovation group (37.8% vs. 15.8%, p = 0.01), although deaths were not aneurysm-related. Median follow-up exceeded 60 months in both groups. Conclusions: Both ULP endografts demonstrated favorable long-term outcomes within the limitations of a non-randomized, anatomically heterogeneous cohort.