Technical Tips for Endovascular Aortic Repair Using the Gore Excluder Abdominal Stent-Graft: Endo-Wedge Technique and Scrum Technique

Tatsuo Banno1, Ryoichi Kato1, Ryota Hanaoka1, Hokuto Akamatsu1, Kan Kaneko2, Hiroshi Toyama1, *
1 Department of Radiology, Fujita Health University School of Medicine, Japan
2 Department of Cardiovascular Surgery, Fujita Health University School of Medicine, Japan

© 2014 Banno et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Radiology, Fujita Health University, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi,470-1192, Japan; Tel: +81-562-93-9259; Fax: +81-562-95-2253; E-mail:


When performing endovascular aortic repair (EVAR) procedures, clinicians sometimes encounter cases in which the indications for EVAR are beyond the instruction for use (IFU). In EVAR, proximal neck fixation is the most important factor. This report describes several techniques and tips for EVAR in cases presenting with a difficult short neck or angled neck, especially when using the Gore Excluder®. Endo-wedge techniques (EWT), including non-sheath-assisted EWT with sheath-assisted strategies, are presented. We describe the scrum technique, which is a special procedure that is only feasible when using the Gore Excluder®. In this technique, intentional wire bending around the proximal neck portion occurs by pushing from both sides of the guidewire. This technique is applicable in cases with a sharply angled neck. The scrum with EWT is a more precise strategy for cases with a short or angled neck. Other troublesome cases include limb occlusion caused by weak points in the Gore Excluder® body and legs. The very rare complication of stent-graft collapse is also reviewed.

Keywords: Endovascular aortic repair (EVAR), Aortic stent graft, Excluder, Abdominal aortic aneurysm (AAA), Guiding catheter (GC), Endo-wedge technique (EWT), Scrum technique.