Technical pitfalls and proposed modifications of instructions for use for endovascular aortic aneurysm repair using the Gore Excluder Conformable Device® in angulated and short landing zones

To describe a case of abdominal aortic aneurysm (AAA) and angulated proximal neck treated with Gore Excluder Conformable® and to show relevant technical pitfalls in the deployment of the graft main body. An 82-year old male presented with a 71 mm asymptomatic AAA with an angulated infrarenal proximal neck (75°) was referred to our unit. The patient was treated with a 26-mm Gore Excluder Conformable® device, which was deployed slightly above the renal arteries after pre-catheterization of the lowest renal artery. The graft was then repositioned with the support of the introducer sheath and a stiff guide wire. The proximal sealing zone was ballooned before the endograft delivery system was retrieved to avoid distal migration. Technical success was achieved. The patient was discharged with no complications. No type 1a Endoleak was present at 6-months CT-Scan. Endovascular treatment of AAA with severe angulated proximal neck can be effective with a conformable stent-graft if technical measures are used during the deployment of the main body to optimize seal.