Abdominal aortic aneurysm repair with the W.L. Gore excluder endovascular stent-graft: Technique and potential pitfalls

The W.L. Gore Excluder (W.L. Gore, Inc, Flagstaff, AZ) is a new endovascular aortic stent-graft undergoing clinical evaluation in the United States and Europe for the treatment of infrarenal abdominal aortic aneurysms. It consists of expanded polytetrafluoroethylene fully supported on a self-expanding nitinol stent and is constrained on the delivery catheter using a novel lacing suture. The device is delivered through an 18F transfemoral sheath to the target site under fluoroscopic guidance and deployed by pulling the restraining suture. For aortoiliac aneurysms, a modular design is used in which the trunk/ipsilateral iliac leg component is initially deployed followed by placement of the contralateral iliac leg (12F). The dimensions of the device, technique of stent-graft deployment, potential pitfalls, and problem-solving maneuvers are described.