IntroductionPatients with complex aortic anatomy require meticulous surgical planning to optimize intraoperative and postoperative outcomes. The GORE Excluder Conformable Abdominal Aortic Aneurysm Endoprosthesis (CEXC Device, WL Gore and Associates, Flagstaff, AZ) allows for endovascular treatment of highly angulated and short proximal neck abdominal aortic aneurysms (AAA). Owing to its recent approval, short-term clinical outcomes of this device remain scarce.ReportIn this report, we present a case series of 3 patients who underwent endovascular aortic repair using the GORE Excluder Conformable device with highly angulated (>70°) aortic neck anatomy. Endografts were deployed in a radiology suite using standard 2D angiography in conjunction with a CYDAR Medical (Wilmington, Delaware) reconstructed 3D overlay. The patients’ ages were 85, 67, and 85 years. The mean abdominal aortic aneurysm diameter in these cases was 6.9 cm. The mean proximal neck length was 2.1 cm, proximal mean neck angulation was 83°. The mean operative time, total fluoroscopy time, and contrast used were 208 minutes, 28.3°minutes, and 94.5 milliliters, respectively. No adjunctive procedures, such as proximal cuff or endo-anchors, were performed at the time of index procedure.DiscussionType Ia endoleak was observed in 1 patient post-operatively but after treatment with an aortic cuff there was no evidence of enlarging aneurysm sac. The GORE Excluder Conformable Endoprosthesis expands access to endovascular management of AAAs. Our early experience with this device demonstrated excellent patient and clinical outcomes in a highly angulated neck anatomy.

中文翻译：

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在大角度主动脉颈解剖中使用 GORE 舒适排除器装置：中期结果

简介具有复杂主动脉解剖结构的患者需要细致的手术计划以优化术中和术后结果。 GORE Exclusionr 适形腹主动脉瘤内假体（CEXC 装置，WL Gore and Associates，弗拉格斯塔夫，亚利桑那州）允许对高度成角和短近端颈腹主动脉瘤 (AAA) 进行血管内治疗。由于最近获得批准，该装置的短期临床结果仍然很少。报告在本报告中，我们介绍了 3 名患者的病例系列，他们使用具有高角度（> 70°）主动脉颈的 GORE Exclusionr 适形装置进行了血管内主动脉修复解剖学。使用标准 2D 血管造影术结合 CYDAR Medical（特拉华州威尔明顿）重建的 3D 叠加将内移植物部署在放射学套件中。患者的年龄分别为 85 岁、67 岁和 85 岁。这些病例中腹主动脉瘤的平均直径为 6.9 厘米。平均近端颈部长度为 2.1 cm，近端平均颈部角度为 83°。平均手术时间、总透视时间和使用的造影剂分别为 208 分钟、28.3° 分钟和 94.5 毫升。索引手术时未进行辅助手术，例如近端套囊或内锚。讨论 1 名患者术后观察到 Ia 型内漏，但在用主动脉套囊治疗后，没有证据表明动脉瘤囊扩大。 GORE Excluder 适形内置假体扩大了 AAA 血管内治疗的范围。我们对该设备的早期经验证明，在高度倾斜的颈部解剖结构中，患者和临床效果都非常出色。