The Gore Excluder AAA endoprosthesis with C3 delivery system: results in high-volume centers

The use of endovascular aortic aneurysm repair (EVAR) has increased dramatically, chiefly because of its low perioperative morbidity compared with open surgery. Challenges to the success of EVAR remain, however, with the most important being features of the patient's infrarenal aortic neck anatomy that make optimal placement of the endoprosthesis difficult. These features include a short, wide, severely angulated, or reverse-tapered neck and the presence of calcifications or thrombus. Suboptimal endograft positioning may necessitate use of aortic cuffs, thereby increasing the time and cost of an EVAR procedure, or increase the likelihood of graft migration, which can lead to endoleaks and additional interventions. Efforts to improve outcomes of EVAR and expand its application in patients with challenging aortic neck anatomy have focused on the development of endografts and delivery systems with innovative designs. The low-permeability Gore Excluder AAA endoprosthesis with C3 delivery system, which became available in Europe and the United States in 2010, represents one such design. The C3 system allows the proximal end of the endoprosthesis to be reconstrained after insertion so that the device can, if necessary, be rotated or moved cranially or caudally. Repositioning may facilitate contralateral gate cannulation and placement of the endograft closer to the lowest renal artery (without covering its orifice), thereby possibly decreasing the risk of inadequate sealing and consequent graft migration and endoleaks. Early clinical studies of the Gore Excluder AAA endoprosthesis with C3 delivery system have yielded promising results.