Systematic Review of Clinical Outcomes With the E-tegra™ Stent Graft System for Endovascular Aneurysm Repair: Endoleaks, Limb Patency, Reinterventions, Aneurysm Sac Behaviour, and Mid-Term Follow-Up

OBJECTIVE: To systematically synthesize the published clinical evidence regarding endovascular aneurysm repair (EVAR) using the E-tegra™ stent graft system, evaluating technical success, endoleaks, limb patency, reinterventions, aneurysm sac behavior, and mid-term follow-up outcomes. METHODS: Conducted according to the PRISMA 2020 framework, systematic searches were performed across PubMed/MEDLINE, Embase, Scopus, and the Cochrane databases. Observational studies and registry reports reporting clinical outcomes of adults undergoing EVAR with the E-tegra system were included. Because of cohort overlap and heterogeneous endpoint definitions, data were synthesized narratively and descriptively without formal quantitative pooling. RESULTS: Three eligible publications were identified, representing 209 unique patients across two underlying cohorts: the multicenter TIGRE registry (147 patients) and an independent single-center series (62 patients). Primary technical success was high, reaching 99.3% in the registry and 100% in the single-center cohort, with zero perioperative mortality across both. At mid-term follow-up (ranging from 18 months to 2 years), type II endoleak and iliac limb occlusion emerged as the primary complications. The TIGRE update reported 16 total complications (10.88%), including 8 type II endoleaks and 6 iliac limb occlusions, with a 2-year reintervention rate of 4.76%. In the single-center series, 1 type IIIa endoleak (1.6%) and 3 clinically significant type II endoleaks requiring embolization were observed. Favorable mid-term sac behavior was noted in the registry, with 72.11% of patients demonstrating >10-mm aneurysm sac shrinkage. Predefined anatomical hostility did not demonstrate a statistically significant association with adverse outcomes or reinterventions in the registry data. CONCLUSIONS: Early and mid-term evidence for the E-tegra stent graft demonstrates high procedural success and acceptable clinical outcomes with competitive mid-term complication and reintervention rates. However, the current literature is strictly limited to single-arm observational data with short-to-medium horizons (18-24 months). Long-term durability and structural performance relative to well-established companion platforms remain unestablished, highlighting the critical need for continued prospective surveillance and comparative, long-term multicenter trials.