Systematic Review, Meta-analysis and Meta-regression on the Prognostic Impact of Narrow Aortic Bifurcation on Outcomes of Endovascular Aneurysm Repair.

PURPOSE: To evaluate whether a narrow aortic bifurcation (NAB) is associated with equal outcomes compared to a conventional aortic bifurcation (RAB) after endovascular aortic repair (EVAR).

METHODS

A systematic literature search of MEDLINE, Embase, and Scopus was performed through August 2025. A random-effect-meta-analysis of proportion was conducted to calculate the pooled odds ratios (OR) with 95% confidence intervals (CIs) for outcomes of interest. Random-effects meta-regression models evaluated the impact of follow-up duration and bifurcation diameter cut-off on treatment effects.

RESULTS

Twelve studies met the inclusion criteria (≈2,300 patients), of which eight were eligible for quantitative synthesis. The meta-analysis revealed no significant differences between NAB and RAB groups regarding primary limb patency, reintervention, or overall mortality with pooled ORs of 0.96 (95% CI, 0.51-1.82), 1.12 (95% CI, 0.58-2.14) and 0.89 (95% CI, 0.43-1.87), respectively. Heterogeneity was moderate across all outcomes (I2 = 25%-48%; P > .10). Meta-regression demonstrated no significant association between treatment effect and either follow-up duration or bifurcation diameter cutoff.

CONCLUSIONS

In this systematic review and meta-analysis of contemporary studies with pooled quantitative and qualitative evidence, NAB was not associated with worse limb patency, reinterventions rates, or mortality following EVAR. Overall, these findings may suggest that modern bifurcated endografts can be used safely and effectively in patients with narrow distal aortic anatomy when appropriate planning and technique are applied.