Purpose: Crossed-limb deployment during endovascular aneurysm repair (EVAR) is occasionally required in patients with challenging anatomy to facilitate contralateral gate cannulation. Concerns regarding long-term durability have limited widespread adoption. This study compared graft-related outcomes following crossed-limb and conventional EVAR deployment. Methods: A retrospective multicentre review was performed of all patients undergoing infrarenal EVAR with the Gore Excluder endograft across seven Western Australian hospitals between 2013 and 2018. Patients treated with crossed-limb EVAR were compared with conventional deployment. Primary outcomes included graft limb occlusion, endoleak and reintervention. Secondary outcomes included perioperative and mid-term mortality, with three-year follow-up. Results: A total of 215 patients were analysed, including 83 crossed-limb and 132 conventional EVARs. Mean age was 70.5 years and 86% were male. No graft limb occlusions occurred in the crossed-limb cohort, while three occurred following conventional EVAR (0% vs 2.3%, p=0.267). Type I endoleak occurred in one patient in the crossed-limb group and two patients in the conventional group (1% vs 1.5%, p=0.85). No Type III endoleaks occurred in the crossed-limb cohort, whereas two occurred in the conventional group (0% vs 1.5%, p=0.524). No 30-day mortality occurred in the crossed-limb cohort, compared with one death in the conventional group (0% vs 0.7%, p=0.427). No aneurysm-related mortality occurred in either group at three years. Late non-aneurysm-related mortality was comparable between groups (1% vs 3%, p=0.387). Conclusion: Crossed-limb EVAR demonstrated durable outcomes comparable to conventional deployment, with no increase in graft limb occlusion, endoleak, reintervention or mortality through mid-term follow-up. These findings support crossed-limb deployment as a safe and effective strategy in patients with challenging aortoiliac anatomy undergoing EVAR.