Feasibility of Aorto-uni-iliac Endovascular Aortic Repair Using the Gore Excluder for Abdominal Aortic Aneurysm

Purpose: To evaluate the feasibility of aorto-uni-iliac endovascular aortic repair using the Gore Excluder in selected patients. Material and Methods: This retrospective study reviewed five cases of aorto-uni-iliac endovascular aortic repair for abdominal aortic aneurysm using the Gore Excluder between January 2014 and January 2024. Patient demographics, procedural details, and postoperative outcomes were evaluated. Study endpoints included technical success, overall survival, aneurysm sac changes, endoleak occurrence, secondary interventions, and aneurysm-related death to evaluate feasibility and mid-term durability. Technical success was defined as successful stent graft deployment without conversion to open repair. Results: The cohort included one elective case in which a dedicated aorto-uni-iliac device was deemed unsuitable, three cases converted intraoperatively from bifurcated to aorto-uni-iliac configuration, and one case in which the dedicated device was unavailable. The aorto-uni-iliac configuration was achieved through off-label use of aortic extenders or an upside-down contralateral leg. All cases were technically successful. Three cases were emergency procedures. All cases required femoro-femoral crossover bypass. Slight type III endoleaks were detected in two cases on completion aortography but had resolved on postoperative computed tomography on days 11 and 16, respectively. No type III endoleaks were observed in any case during follow-up. No aneurysm-related deaths occurred. Over a median follow-up of 35 months (range: 1-62; excluding one same-day death), no sac enlargement was observed, suggesting acceptable durability. Median overall survival was 1,100 days (range: 0-1,966). Conclusions: Aorto-uni-iliac endovascular aortic repair using the Gore Excluder for abdominal aortic aneurysm is feasible when dedicated aorto-uni-iliac devices are unavailable or unsuitable, particularly in emergencies.