Initial Clinical Experience With A New Conformable Abdominal Endograft: Precision of Deployment and Tortuosity Index Analysis in Challenging Aortic Neck

Introduction: Improvement in planning, materials and techniques have allowed to establish endovascular aneurysm repair (EVAR) as the standard treatment of abdominal aortic aneurysm (AAA). Despite endograft evolution, short and angulated proximal aortic neck still represent a challenge for EVAR and few data are available on device conformability in these anatomies. The aim of this preliminary experience is to analyze precision of deployment and conformability of a new generation infrarenal endograft by comparing pre- and postoperative tortuosity index at different aorto-iliac segments. Methods: Between November 2018 and March 2019 we treated nine patients (8 men, mean age 73.9 years ± 8.5) with elective EVAR using the new bifurcated Gore Excluder Conformable AAA Endoprosthesis with Active Control System (W. L. Gore & Associates, Flagstaff, Ariz). Five (55%) patients required an iliac side-branch for a concomitant iliac aneurysm. Precision of deployment was calculated by centerline distance measurement between the lowest renal artery and the proximal endograft fabric (renal to fabric distance, RFD). Analysis of conformability was performed by comparing pre and postoperative aortic neck angulation and tortuosity index (TI) at different aortic levels. All measurements were obtained by comparing preoperative and 30-day CTA scan using the Aquarius iNtuition Software (TeraRecon Inc, Foster City, California, USA). Results: Technical success was obtained in all the cases without the need for additional procedures. We used active control system in 7 out of 9 patients (77%). Six patients (66%) received a total percutaneous EVAR under local anesthesia. No postoperative and 30-days complications were observed. Mean length of the proximal aortic neck was 19.7 mm ± 11.5 (range 11.1-44.6). At 30-day control CTA-scan, mean RFD was 2.9 mm ± 2.9 (range 0.8-9.9). We did not observe significant changes between pre- and postoperative proximal aortic neck angulation (39.3° ± 27.2 vs 37.3° ± 24.3, p = 0.984). Similarly, there were no significant TI differences between preoperative and 30-day CTA-scan at the level of aortic neck (1.01 ± 0.05 vs 1.01 ± 0.01, p = 0.732) and infrarenal aorta (1.25 ± 0.15 vs 1.21 ± 0.11, p = 0.215). Postoperative tortuosity index was significantly lower on the right iliac axis (1.28 ± 0.12 vs 1.18 ± 0.09, p = 0.013) but not on the left iliac axis (1.31 ± 0.13 vs 1.25 ± 0.11, p = 0.092). Conclusion: Our early experience shows that deployment of the Gore Excluder Conformable AAA Endoprosthesis is safe and effective. The new delivery system with active control allows for a precise deployment in patients with challenging proximal aortic neck. Absence of significant changes between pre- and postoperative proximal aortic neck angulation and tortuosity index confirms the high conformability of this endograft. Disclosure: Nothing to disclose