The effect of endograft relining on sac expansion after endovascular aneurysm repair with the original-permeability Gore Excluder abdominal aortic aneurysm endoprosthesis

Explanted Excluder removed because of sac expansion in the absence of endoleak. Note the proteinaceous material deposited throughout the area where the graft was within the aneurysm sac. The only place within the sac where material did not accumulate on the graft was on the docking limb where it overlaps with the contralateral limb, creating two thicknesses of graft material. This reinforced our belief that two thicknesses of graft material might prevent the transmigration of fluid that appears to be causing sac expansion in the absence of endoleak.

Relining strategy. Relining was performed in one of three ways. A, First, if only the limbs were in contact with the sac, only the limbs were relined, using Excluder limbs delivered via bilateral 12F sheaths. Alternatively, if both limbs and the lower portion of the main body were in contact with the sac, we relined both the limbs and the lower portion of the main body, in one of two ways. B, If the main body was 23 mm in diameter, this was accomplished with only two limbs by advancing the bifurcation. This is possible because the diameter of two Excluder limbs, which are 16 mm in diameter proximally, have essentially the same cross-sectional area as a 23-mm diameter main body. C, For the larger 26-mm and 28-mm diameter main body Excluder devices, relining required an aortic cuff to cover the lower portion of the main body, followed by bilateral limb placement to reline the remainder of the graft. This requires an 18F sheath on one side and a 12F sheath on the other.

Pattern of change in (A) abdominal aortic aneurysm (AAA) diameter and (B) AAA three-dimensional volume in a single patient after endovascular aneurysm repair (EVAR).