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Introduction
Stent graft oversizing is essential for fixation and sealing during thoracic endovascular aortic aneurysm repair (TEVAR). However, excessive oversizing may lead to infolding of the graft or progressive dilatation of the aortic neck. The aim of this study is to investigate the influence of oversizing on stent graft related complications in TEVAR patients.
Methods:
A total 337 patients with thoracic aortic aneurysm (TAA) treated with TEVAR were identified as part of the TAG (W. L. Gore and Associates, Flagstaff, Ariz) thoracic stent graft trials. Patients were stratified based on the percentage of oversizing at the proximal landing-zone (Group 1: <10% , Group 2: 10-20% and Group 3: > 20%), and short and long-term outcomes were compared.

Results:
Patients in group 1 had a significantly larger pre-operative proximal aortic diameter (32.6mm vs. 31.3mm vs. 28.2mm; p < .0001) and proximal aortic neck length (6.9cm vs. 5.8cm vs. 5.2cm: p = .035). Overall, type 1 endoleak was the most frequent complication during the first 30 days of follow-up, but did not differ between groups (10.6% vs. 11.2% vs. 7.8%; p = .809). A trend was noted for type I endoleak during long-term follow-up (9.4% vs. 3.2% vs. 7.8%; p = .073) but no significant differences in device-related complications were observed between groups. Cox proportional hazards model showed no difference for time to type I endoleak between oversizing groups [Group 1 vs. 2, HR: 1.24 (95% CI: 0.65 - 2.36; p=0.509) Group 3 vs 2, HR: 1.24 (95% CI 0.60 - 2.60; p=0.562)].

Conclusion
The percentage of oversizing did not significantly affect the incidence of device-related complications after TEVAR for TAA. The current guidelines regarding stent graft oversizing for TAA seem appropriate and justified.