Sizing Considerations for GORE Excluder in Angulated Aortic Aneurysm Necks

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortic Aneurysm Repair

Background:

• Selecting devices for endovascular treatment of abdominal aortic aneurysms (AAAs) with challenging neck anatomy (>60° angulation) is difficult.
• Current practices may involve graft oversizing in these cases, but its impact on endoleak risk is unclear.

Purpose of the Study:

• To determine if graft oversizing is necessitated by abdominal aortic aneurysms (AAAs) with proximal neck angulation >60°.
• To investigate whether graft oversizing in such cases increases the risk of type 1A endoleaks.

Main Methods:

• Prospective analysis of patients undergoing endovascular aneurysm repair (EVAR) with a C3 Gore Excluder device.
• Inclusion criteria: aortic anatomy with proximal neck angulation >60°, defined as outside Instructions for Use (IFU).

Main Results:

• 127 patients (9.2%) with AAA neck angulation >60° were analyzed.
• Mean neck angle was 78.0°, mean neck length 2.88 cm, and mean graft oversize 23.5%.
• 7 type 1A endoleaks occurred (5.5% overall); neck length, angle, and graft oversizing were not predictors.

Conclusions:

• Endovascular specialists are not adhering to IFU for EVAR device selection in AAAs with >60° neck angulation.
• Deviation from IFU and graft oversizing in this cohort were not associated with an increased risk of type 1A endoleaks.