Endovascular Repair with EGoist Flex Wire and EXCLUDER Conformable Stent Graft for Abdominal Aortic Aneurysm with a Severely Angulated Neck

Endovascular repair for an abdominal aortic aneurysm (AAA) with a severely angulated proximal neck is challenging and generally requires specific techniques, such as through-and-through bowing and push-ups. In addition, it may be difficult to advance the pulled extra-stiff wire without any catheter support, which is associated with a high risk of aortic injury and requires wire exchange. Recently, the EXCLUDER Conformable stent graft with angulation by an active control system and the EGoist Flex and Fitto extra-stiff wire, with an extra-long flexible section of > 35 cm, has been commercialized. We present successful cases that were treated with endovascular repair using the EXCLUDER Conformable stent graft and EGoist Flex wire for severely angulated AAA without wire exchange. A 78-year-old female and an 83-year-old male had dilated AAAs with severely angulated proximal necks at > 110°, which were indications for these interventions. Because of their condition, we chose endovascular repair, even though their proximal necks were severely angulated. The patients obtained good results without a type 1a endoleak by deployment of the stent graft along the angulated aorta using the active control system of the stent graft and an extra-long flexible section of the wire. Postoperative computed tomography revealed good outcomes without endoleaks, and the patients were discharged uneventfully. Use of the EXCLUDER Conformable stent graft and EGoist Flex wire may be effective and safe for severely angulated AAA.