Endovascular aortic repair with the Gore Excluder Conformable endograft in severe neck angulation: Preliminary experience and technical aspects

Abstract

Objectives Endovascular procedures are now the standard of care for endovascular aortic aneurysm repair but treatment of hostile proximal neck anatomy is still challenging. New endografts were brought to the market specifically designed to accommodate severe neck angulation. Authors describe a preliminary experience and early results using the Gore Excluder Conformable endograft (W. L. Gore & Associates, Flagstaff, Ariz) and its active control system in severe neck angulation with a standardized technical approach to achieve precise deployment in this hostile anatomy. Methods From June 2019 to May 2020, five patients with abdominal aortic aneurysm and severe neck angulation (≥70°) were treated with the Gore Excluder Conformable endograft at two different centers. Deployment of this endograft in this kind of anatomy should be aggressive starting over the level of renal arteries due to risk of distal migration downward on the external curvature and difficulty in upward repositioning. Authors suggested a standard technique with a routine through-and-through axillary–femoral approach, using a floppy guidewire together with preventive cannulation of the lower renal artery if a short neck (<15 mm) is associated. Results Endovascular aortic procedures were successfully completed in all patients. Final deployment of the stent graft using our standardized technical approach was extremely precise in all cases even if redeployment of the graft was necessary in all cases. No other secondary procedures were needed. At 30 days, no type IA endoleak was recorded and no aneurysm-related secondary procedures were performed. Median follow-up for this group of patients was 5.2 months (range 1–11). Early results revealed no type IA endoleak and no migration at Ct angiogram. No aneurysm-related secondary procedures were required. Conclusion Routine use of through-and-through axillary–femoral guidewire associated with selective pre-cannulation of the lower renal artery allows a precise deployment of the Gore Excluder Conformable endograft in difficult anatomies possibly affecting early outcomes.

Long-term Results of Angulated Versus Hyperangulated Neck in Endovascular Aneurysm Repair With Endurant Endoprosthesis

“…The first studies showed good results, without type IA endoleak, migration or secondary procedures. 19 However, long-term outcomes have to be evaluated.…”

Endovascular Treatment of Abdominal Aortic Aneurysm With Severe Angulation of Infrarenal Aortic Neck by Gore Conformable Endograft

“…12 To date, only few small clinical series on EVAR with this device have been reported in the literature, with lack of results on the severe angulated aortic neck. [12][13][14] The aim of this study was to report 2 years of singlecenter experience with CEXC Device in severe angulated neck AAAs.…”

Endografts for the treatment of abdominal aortic aneurysms with a hostile neck anatomy: A systematic review

“…In order to be labeled as hostile, the AAA neck has to have any of the following features: (1) >2 mm reverse taper within 1 cm below the renal arteries, (2) ≥60° angulation within 3 cm below renal arteries, (3) ≤10 mm neck length, (4) neck thrombus of ≥50% of circumference, and (5) >3 mm focal bulge in the neck ( 7 ). Others refer to the hostile aortic neck length as ≤15 mm ( 8 , 9 ), with this length being the minimum requirement for most endografts.…”