Sheath-assisted controlled deployment technique for Excluder bifurcated main body

The W. L. Gore Excluder bifurcated device uses a single-action deployment mechanism with an expanded polytetrafluoroethylene string that is stitched to an outer jacket constraining the nitinol self-expanding stent-graft. Under certain anatomic conditions of the proximal neck, the deployment angle of the proximal stent-graft can be difficult to predict and result in the device being seated caudal to the intended landing site just below the lowermost renal artery. This article describes a technique of controlled deployment of the Excluder device where the top of the main bifurcated device is “flowered” by slowly pulling the deployment string while being buttressed by an introducer sheath to prevent premature deployment and allow longitudinal positioning of the device. This technique could be used when a more gradual deployment of the Excluder device is desired in angulated or short proximal necks.