Pre-constrain technique using the Gore Excluder Conformable endograft for abdominal aortic aneurysm with severely angulated proximal neck

Figures

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  Fig 1. The comparison of traditional deployment (A-D) and pre-constrain technique (A-D) during proximal deployment of the Excluder Conformable endograft. After the Gore Excluder Conformable endograft was advanced to the infrarenal aorta, the angulation knob was rotated clockwise to advance the angulation wire (A). The proximal deployment knob was pulled away for deploying the first sleeve (B). At this point, predicting the behavior of proximal stent during deployment is difficult (B′). Constraining and repositioning of the proximal trunk was performed (C). The proximal deployment was completed after unconstraining of the proximal trunk (D). The same steps were performed until advancing the main graft and angulation wire (A). The proximal deployment knob was pulled carefully to the level where the constrain knob is visible, and the constraining dial was rotated for maximal constraining of the proximal edge (B). The first sleeve was deployed to the level of the fourth or fifth stent from the top and position the proximal trunk properly (C). The proximal deployment was completed after unconstraing of the proximal trunk (D). At this point, predicting behavior of proximal stent during…

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  Fig 2. The pre-constrain technique for a severely angulated proximal neck (110°) in Case 1 is shown. The pre-constrain technique kept the proximal trunk narrow after deployment of the first sleeve (yellow arrow) and enabled it to achieve good flexibility in the proximal trunk (red arrow).

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  Fig 3. Maximal angulated proximal neck of the Excluder Conformable endograft before (A) and after the first sleeve is removed (B). The proximal trunk is more angulated after the first sleeve is removed.