Background:Endovascular aortic aneurysm repair (EVAR) has become a valid alternative to surgical open repair for patients with anatomically suitable infrarenal abdominal aortic aneurysm (AAA). However, whether the patients treated with the third generation devices (Cook Zenith and Gore Excluder) have the same clinical courses still remains to be determined. The aim of this study is to compare the peri-procedural and follow-up outcomes of the patient groups treated with those two types of devices.Methods: A total of 69 patients with infrarenal AAA who underwent EVAR with Cook Zenith (n=41, age 70짹7 years) or Gore Excluder (n=28, age 71짹8 years) at Severance Hospital between August 1, 2005 and July 31, 2008 were evaluated in the present study. CT scans were performed either at discharge or within 1 month, 6 and 12 months, and yearly thereafter.Results:Baseline neck and aneurysmal sac diameter were significantly larger in Zenith group (p = 0.008, p=0.003, respectively). There was a trend of the higher neck angle and shorter neck length in Zenith group. Technical success was achieved in 54 patients (78.3%). Immediate postprocedural Type I endoleak was seen in 21.4% of Gore group and in 22.0% of Zenith group at final angiogram (p=0.959). Endoleaks of different types were found more frequently in Excluder group (26.8% vs. 50.0%, p=0.025) on CT prior to discharge. There were no procedure-related mortality or complications requiring surgical conversion. Peri-procedural puncture site complications were similar between the groups. Mean follow-up durations were 14짹11 months for Zenith group and 15짹11 months for Excluder group. Primary outcomes including all-cause mortality and aneurysm-related mortality and aneurysm rupture were essentially not different between both groups. There was one case of aneurysm-related death in Zenith group. There was no aneurysm rupture during follow-up period. Re-intervention rate was similar in both groups (4.9% vs. 3.6%, p=0.826). There were no significant differences in the prevalence of endoleak between the devices during follow-up (12.5% vs.25.0%, p = 0.338) but, aneurysm sac diameter growth > 5mm was more common in Excluder group (2.4% vs. 17.9%, p=0.045).Conclusion:EVAR performed with Zenith and Excluder demonstrated similar clinical outcomes. However, Excluder was associated with more frequent peri-procedural endoleak and aneurysm expansion during follow-up. The comparison between the two devices may have limitations in interpretation because of the obvious clinical selection bias according to the patient���s specific anatomy as shown in this study.