GORE EXCLUDER® AAA Endoprosthesis in Tortuous Anatomy
Heitham Hassoun, MD
Johns Hopkins Hospital
Baltimore, Maryland, USA
CLINICAL CHALLENGE
The patient is an active 85-year-old gentleman with a history of smoking and a family
history of aortic aneurysm. He underwent a CT scan for transient abdominal pain at an
outside hospital and a 6 cm infrarenal AAA was discovered. He has had no history of
heart disease, and his ejection fraction by echocardiogram was 60%. He was
recommended to undergo an open repair because of his tortuous left iliac artery. He
subsequently self-referred to Johns Hopkins Hospital for a second opinion.
Review of his aortic anatomy revealed a 20 mm diameter angulated proximal neck, 18
mm distal aortic diameter, 16 mm diameter short right common iliac artery, and a 12 mm
diameter left common iliac artery, and the treatment length was 16 cm bilaterally.
PROCEDURE
The patient underwent a totally percutaneous repair with the GORE EXCLUDER® AAA
Endoprosthesis using the following devices: 23 mm X 14.5 mm X 12 cm trunk-ipsilateral,
18 mm X 10 cm contralateral limb as extension, and a 14 mm X 12 cm contralateral limb.
Due to the angulated proximal neck and a lower left renal artery, we performed “slow
deployment” with the shorter contralateral side attaining primary fixation below the right
renal artery, thus allowing favorable "tilt" of the device to achieve greater seal.
RESULTS
The procedure was uncomplicated and the patient was discharged to home on
post-operative day one. He resumed normal activities and a 3-phase CT scan was
performed at one month which revealed aneurysm exclusion without endoleak (figure 4).
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