The femoral-based endowedge technique to increase juxtarenal seal and correct graft tilt

The endowedge technique refers to the use of balloons to align the scallops of the Gore Excluder endoprosthesis (W. L. Gore and Associates, Flagstaff, Ariz) to the renal artery to increase juxtarenal seal during endovascular repair of aneurysms with challenging anatomy. With the availability of a reconstrainable deployment system, this now can be performed without the use of brachial access. In addition, the femoral approach facilitates the use of the balloon as a fulcrum to correct unfavorable graft tilt.