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Objectives: In order to reduce the abdominal aortic aneurysm (AAA)-related complication rate in endovascular aneurysm repair (EVAR) procedures, manufacturers recommend following the instructions for use (IFU). However, IFU is considered too conservative in many centers. In this context, we present our experience and patient follow-up data with 248 consecutive patients with or without IFU eligibility. Methods: A total of 248 patients who underwent elective EVAR for AAA between 2014 and 2019 were included. In total, 190 patients were in the IFU group and 58 in the non-IFU group. Patients were evaluated for baseline demographic and anatomic data; unexpected periprocedural intervention; and postoperative data such as development of endoleaks during follow-up, need for re-intervention, development of complications, EVAR patency, and mean 5-year survival rate. Results: The patients did not differ in terms of basic demographic data. The basic anatomical data were suitable for the IFU standard. Intraoperative endoleak development was significantly higher in the non-IFU group. In addition, the development of endoleaks at any time, the need for re-intervention, and the development of complications were higher in the non-IFU group at postoperative follow-up. Survival analysis showed no difference in the mean 5-year follow-up. The EVAR patency rate was higher in the IFU group. Conclusions: We believe that the decision for a non-IFU EVAR should be patient-specific and that the results of the subjective medical assessment should definitely be taken into account. However, we should not forget that EVAR patients, especially non-IFU patients, are susceptible to future changes in the aorta and prone to the development of endoleaks and re-interventions.

Background/Objectives: Acute type A aortic dissection is among the many types of catastrophic cardiovascular emergencies. The development of serious morbidity, especially neurological complications after the operation, remains a huge threat. We aimed to present comparatively the results of using unilateral or bilateral antegrade cerebral perfusion to minimize these threats and to demonstrate the postoperative effects of antegrade cerebral perfusion choices. Methods: The 147 patients who underwent emergency acute type A aortic dissection surgery between January 2018 and January 2023 were evaluated retrospectively. The patients were divided into two groups: those who underwent unilateral antegrade cerebral perfusion (Group 1) (n = 89) and those who underwent bilateral antegrade cerebral perfusion (Group 2) (n = 59). Baseline demographics, and preoperative, operative, and postoperative data of patients were compared statistically. Results: When the analyses of baseline demographics, and preoperative and operative data were evaluated, no significant difference was found between the groups. In addition, when comparing postoperative results, no statistical difference was found between the groups except for new-onset permanent neurological complications. The rate of postoperative new-onset permanent neurological complications was found to be 17.9% in group 1, where unilateral antegrade cerebral perfusion was applied, and 5.1% in group 2, where bilateral antegrade cerebral perfusion was applied, and this comparison was statistically significant. Conclusions: The competence of the Willis Polygon should not be relied upon without any evidence, and we believe that bilateral antegrade cerebral perfusion can be performed with a technique that does not compromise surgical comfort.