Sizing Considerations for GORE Excluder in Angulated Aortic Aneurysm Necks

Background: Device selection for endovascular treatment of abdominal aortic aneurysms (AAAs) with necks >60 degrees is challenging. We sought to identify whether such anatomy necessitated graft oversizing during (endovascular aneurysm repair [EVAR]), and whether this increased the risk of type 1A endoleaks. Methods: Prospective analysis of patients undergoing implantation of a C3 Gore Excluder, with aortic anatomy defined as outside Instructions for Use (IFU) due to proximal neck angulation >60 degrees was performed. Results: Of the 1,394 patients enrolled, 127 patients (9.2%) were included, with median follow-up of 236 days. Mean neck angle was 78.0 +/- 13.2%, neck length 2.88 +/- 1.31, and mean graft oversize 23.5 +/- 9.6%. There were 7 type 1A endoleaks (5.5% males, 5.6% females). Neither neck length, angle, nor degree of oversizing were predictors of type IA endoleak. Conclusions: In conclusion, when selecting endografts for patients with proximal neck angulation over 60 degrees, endovascular interventionalists are not adhering to IFU. However, this was not associated with increased risk of type 1A endoleaks.